Acute spontaneous pneumomediastinum in a child with Hodgkin's disease and pulmonary fibrosis

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.