Pneumomediastinum

What is pneumomediastinum?

Pneumomediastinum (pronounced “noo-mow-mee-dee-A-stuh-num”) is a condition where you have air in the space in the middle of your chest between your lungs (mediastinum) and around your heart. It’s usually caused by an injury, illness or surgery. While the condition itself is usually harmless, underlying causes can be serious.

Pneumomediastinum is also called mediastinal emphysema.

Types of pneumomediastinum

Pneumomediastinum can either be spontaneous or secondary. Spontaneous pneumomediastinum (SPM) isn’t caused by injury or illness, or the cause is unknown. Secondary pneumomediastinum develops because of an injury or illness.

How common is pneumomediastinum?

Pneumomediastinum is uncommon. Experts estimate that it affects 1 in 25,000 people between the ages of 5 and 34 (the group most affected by SPM).

Is pneumomediastinum an emergency?

Spontaneous pneumomediastinum isn’t an emergency. But if you have air in your mediastinum due to an injury or illness, you should be treated right away. Go to the nearest emergency room or seek medical care immediately if you have chest pain and shortness of breath. These could be signs of life-threatening illnesses or conditions.

What’s the difference between pneumomediastinum and pneumothorax?

Pneumothorax is a collapsed lung. It happens when there’s air between your lung and chest wall. The air pushes on your lung until it collapses under the pressure. Pneumomediastinum is air in the space between your lungs, in the center of your chest. This area is called your mediastinum.

What are the symptoms of pneumomediastinum?

Symptoms of pneumomediastinum include:

• Severe pain in the middle of your chest or breastbone. It may radiate to your arms or neck. The pain may be worse with breathing or swallowing.
• Shortness of breath.
• Air pockets under your skin on your face, neck or chest (subcutaneous emphysema).
• Neck or face swelling.
• High-pitched voice or other voice distortion.

Some people don’t have any symptoms.

What causes pneumomediastinum?

Pneumomediastinum is usually caused by air moving into your mediastinum from an injury to an internal organ or structure. This includes your airways (trachea or bronchi), air sacs in your lungs (alveoli), tube from your throat to your stomach (esophagus) or intestines.

Anything that increases pressure in your chest can cause spontaneous pneumomediastinum, though this is rare. Sometimes, your provider can’t find the cause.

Examples of pneumomediastinum causes

Examples of specific causes of pneumomediastinum include:

• Severe injury (trauma) to your chest.
• Surgery.
• Rupture of the small sacs of your lungs (alveoli).
• Tear in your airways or gastrointestinal (GI) tract.
• Bacterial, fungal or viral infections.
• Excessive coughing, sneezing, vomiting and other body functions that increase pressure in your chest suddenly.
• Bearing down while going to the bathroom.
• Pushing during childbirth.
• Inhaling cocaine or marijuana.
• Scuba diving.
• Mechanical ventilation.

What are the risk factors for pneumomediastinum?

You might be at higher risk for pneumomediastinum if you:

• Smoke.
• Have asthma, COPD or other lung conditions.
• Use inhaled recreational drugs.
• Recently had surgery on your abdomen, neck or chest.
• Recently gave birth.

What are the complications of pneumomediastinum?

Some rare complications of pneumomediastinum are life-threatening and need to be treated right away. They include:

• Buildup of air might push on the area around your lungs, causing one to collapse (pneumothorax).
• Air may move from the mediastinum to the area between your heart and the sac around it (pneumopericardium).
• If too much air builds up, it can put pressure on structures in your chest, including your heart and blood vessels. They may not work properly if this happens.

How is pneumomediastinum diagnosed?

A healthcare provider diagnoses pneumomediastinum with a chest X-ray or CT scan. These are tests that take pictures of the inside of your chest. They’ll order them after listening to your heart and lungs. Hearing a crunching sound in time with your heartbeat (Hamman’s sign) is a sign that you might have air in your mediastinum.

How is pneumomediastinum treated?

There’s no specific treatment for pneumomediastinum. It’s usually not serious and your body will absorb the air on its own. Oxygen therapy can speed this up. If you have an underlying health condition, like an infection or injury to an internal organ, your provider will treat you for that condition.

Treatments

Your provider may admit you to the hospital for 24 hours or longer for observation or treatment. While there, they might treat you with:

• Oxygen therapy. Breathing in additional oxygen can help the air absorb into your body faster.
• Medication. Medication like pain relievers or cough suppressants can ease your symptoms until your body absorbs the extra air.
• Needle aspiration. If you have a lot of air that’s pressing on structures inside of your body, a provider may remove some with a needle or put a drain in. This is rare.

Can pneumomediastinum be fatal?

Pneumomediastinum isn’t fatal on its own. But sometimes, serious, life-threatening health conditions can cause it. Your provider will look for causes of the air and treat them if necessary.

Can pneumomediastinum be prevented?

Pneumomediastinum is rare and researchers don’t understand all the causes or risk factors. There aren’t any recommended ways to prevent it. Not smoking and not using inhaled recreational drugs might lower your risk.

How do you recover from pneumomediastinum?

People with spontaneous pneumomediastinum (SPM) spend an average of three days in the hospital, but are sometimes there for a week or more. People with underlying causes of pneumomediastinum can be hospitalized for several weeks.

Can pneumomediastinum be cured?

Spontaneous pneumomediastinum usually goes away on its own without treatment. If it wasn’t caused by an underlying health condition, it shouldn’t come back. The health conditions that cause it can sometimes be cured.

What is the outlook for pneumomediastinum?

Your outlook will depend on what’s causing the air in your mediastinum. People with spontaneous pneumomediastinum can make a full recovery and rarely have it happen again. If you have secondary pneumomediastinum, recovery will depend on the severity of your underlying condition. Some conditions that cause pneumomediastinum can be fatal.

When should I seek care?

See a healthcare provider if you’re experiencing discomfort in your chest, face swelling or unexpected changes in your voice, especially if you’ve recently had surgery or given birth.

When should I go to the ER?

Seek medical attention or go to the nearest emergency room immediately if you’re experiencing:

• Chest pain.
• Shortness of breath.
• Severe face or neck swelling.
• Lightheadedness.

What questions should I ask my doctor?

It might be helpful to ask your provider:

• What caused this?
• How serious is my condition?
• How do I treat the cause?
• What are my treatment options?
• How long will it take to feel better?
• How can I prevent it from happening again?

A note from Cleveland Clinic

Spontaneous pneumomediastinum (SPM) usually isn’t serious, though you could spend several days in the hospital. But secondary pneumomediastinum — after an illness or injury — means you need to treat the underlying cause right away. Your provider will let you know what to expect based on your specific situation.