Spontaneous pneumomediastinum in children

Spontaneous pneumomediastinum (SPM) is rare in children, mainly affecting m ale adolescents. It is usually secondary to alveolar rupture in the pulmona ry interstitium, followed by dissection of gas towards the hilum and medias tinum. Many pathological and physiological events can lead to alveolar rupt ure, but the most common cause in children is asthma. The clinical diagnosi s is based on the symptom triad of chest pain, dyspnea, and subcutaneous em physema. and is also based on Hamman's sign. The diagnosis is confirmed by chest radiography. The main differential diagnosis is esophageal perforatio n, which requires an esophagogram with contrast when there is the slightest doubt in the diagnosis. Spontaneous pneumomediastinum generally resolves s pontaneously within a few days, meaning that ambulatory treatment is usuall y appropriate. Management consists of treating the underlying cause (if ide ntified), rest, analgesics, and simple clinical monitoring. Predisposing fa ctors should be identified and controlled to prevent recurrence. Cases of i diopathic SPM necessitate diagnostic pulmonary function tests after the acu te episode, to establish whether the child has asthma. (C) 2000 Wiley-Liss. Inc.