G. Briassoulis et al., Acute spontaneous pneumomediastinum in a child with Hodgkin's disease and pulmonary fibrosis, PED HEM ONC, 16(2), 1999, pp. 175-180
A case of acute spontaneous pneumomediastinum in a 13-year-old boy sufferin
g from Hodgkin's disease and pulmonary fibrosis is reported. He was initial
ly treated for Pneumocystis carinii but his respiratory function progressiv
ely deteriorated and fibrosis secondary to bleomycin was suspected. The day
before the admission to the Pediatric Intensive Care Unit the patient comp
lained of anterior thoracic pain and a chest x-ray revealed a left-sided sm
all spontaneous pneumothorax and pneumomediastinum. Although air leak respo
nded initially to conservative treatment, acute tension pneumomediastinum w
ith cardiopulmonary decompensation recurred 6 days Eater; while the Patient
was on mechanical ventilation. Treatment with urgent evacuation of the acc
umulated air via subxiphoid drainage, using an old but ill-de;fined techniq
ue, resulted in complete resolution of pneumomediastinum and significant im
provement of the hemodynamic condition.