Etiologies of spontaneous pneumomediastinum in children in middle Taiwan

Abstract

Introduction: Spontaneous pneumomediastinum (SPM), while rare, is probably underestimated in children. Treatment targets on the underlying disease and trigger factors. The study aimed in analysis different etiology in different age groups. Patients and Methods: Total 37 children with SPM were analyzed from two medical centers in middle Taiwan from 1994 to 2007. Results: Incidence of SPM in children was 1:11,726 patients at Department of Pediatric Emergency in middle Taiwan. Bimodal peak in incidence occurred in those under 7 and in those aged 15-18 years old. The Characteristic symptoms were dyspnea (64.9%), followed by chest pain (62.2%) and neck pain (40.5%); common specific physical signs were subcutaneous emphysema (SCE) (67.6%) and Hammer's sign (13.5%). Trigger factors were infection (43.2%), asthma (21.0%), esophageal rupture (5.4%), foreign body aspiration (2.7%), and diabetic ketoacidosis (2.7%). Idiopathic SPM accounted for 35.1% of patients with mean age 14.1 years. In age distribution, preschoolers (<7 years old) got SPM mostly due to lower respiratory tract infection. In adolescents, the most common etiologies were asthma and upper respiratory tract infection. Mean hospitalization was 6.4 days. Although 17 (46.0%) patients needed intensive care, nearly all had complete resolution in chest radiography before discharge. Conclusion: Clinician should keep alert to incidence of SPM from these symptoms. Etiologies varied with age and treatment must target on factors and underlying disease. © 2010 Wiley-Liss, Inc.