Medical causes of pneumomediastinum in children

The purpose of this study was to determine the possible causes, clinical fi ndings, and associated complications of pneumomediastinum in children, Medi cal records from January 1985 to December 1994 were retrospectively reviewe d at Children's Hospital Medical Center of Akron using International Classi fication of Diseases, ninth revision, codes to identify cases of pneumomedi astinum, The medical causes, nontraumatic and noniatrogenic, of pneumomedia stinum were studied; intubated or trauma patients and patients having under gone procedures were excluded. Neonates were also excluded. Twenty-nine cas es of pneumomediastinum were identified. Two patients (7%) had recurrent pn eumomediastinum. Only the first episode of pneumomediastinum was included i n the data analysis. Twenty males (69%) and nine females (31%) were affecte d, The most common medical causes of pneumomediastinum were asthma exacerba tions (17/59%) and infections (8/28%). Over the 10-year period, the prevale nce of pneumomediastinum in children with asthma exacerbations was 0.2% (21 /10,472); 1% (1/126) in children with airway foreign bodies and 0.2% (1/351 ) in children with esophageal foreign bodies. The most common signs and sym ptoms were subcutaneous emphysema (22/76%), sore throat or neck pain (11/38 %), and Hamman's crunch (3/10%), The most common complication was pneumotho rax with small pneumothoraces in 2 patients (7%) and a tension pneumothorax in I asthmatic with recurrent pneumomediastinum. Patients without sore thr oat or neck pain and patients admitted to the intensive care unit had great er hospital lengths of stay. Pneumomediastinum appears to be uncommon in ch ildren, The most common medical causes were asthma and infections, The most common signs and symptoms were subcutaneous emphysema, sore throat or neck pain, and Hamman's crunch. The most common complication was pneumothorax, The clinical significance of pneumomediastinum is its cause and association with significant complications.