Jornal Britânico de Pesquisa Acesso livre

Abstrato

Spontaneous pneumomediastinum and pneumopericardium in a young, healthy adult with plans for intercontinental travel.

Dr J Winterton

A 23 year old male presented to the emergency department
complaining of sudden onset chest and neck pain, dyspnoea
and dysphonia, following an episode of vigorous coughing.
Clinical examination revealed a mild tachycardia and evidence
of surgical emphysema in the left supraclavicular fossa. A chest
x-ray confirmed surgical emphysema in the left side of the neck
and raised the concern of pneumomediastinum. The subsequent
CT scan identified both pneumomediastinum and more
surprisingly, pneumopericardium. The lung fields were normal.
This spontaneous event was treated conservatively with
analgesia and observation. The patient remained stable and
was discharged after 48 hours with safety net advice and a plan
for appropriate follow up. Pneumomediastinum and pneumopericardium
should be a consideration in adult patients
presenting with sudden onset chest pain whilst free air in the
subcutaneous tissues and mediastinum warrant urgent CT to
exclude life threatening causes. Spontaneous pneumomediastinum
and pneumopericardium can be caused by the Macklin
effect - potentiated by vigorous coughing. The management of
spontaneous pneumomediastinum and pneumopericardium is
largely conservative, but life-threateneing sequelae can develop.
Following symptom resolution, clear communication with
the patient regarding the potential severity of the sequelae of
pneumomediastinum and pneumopericardium is essential to
ensure a period of inpatient assessment to confirm safety for
discharge and resolution of free air at follow up. This is particularly
relevant in a young, healthy patient cohort, who may
feel that information given at follow up will be restrictive and
detrimental to their life plans.