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Lee, Son, Kim, Kim, and Park: Characteristics of pediatric noniatrogenic pneumomediasinum
Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(2): 145-150.

Published online: 24 March 2015

DOI: https://doi.org/10.4168/aard.2015.3.2.145

Characteristics of pediatric noniatrogenic pneumomediasinum

Narae Lee1, Seung Kook Son1, Hyung Young Kim1, Hye-Young Kim2, Hee Ju Park1

1Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.

2Department of Pediatrics, Pusan National University Hospital, Busan, Korea.

Correspondence to: Hee Ju Park. Department of Pediatrics, Pusan National University Children's Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-700, Korea. Tel: +82-55-360-3150, Fax: +82-55-360-2181, phj7294@hanmail.net

Received 17 September 2014       Revised 6 November 2014       Accepted 28 November 2014

© 2015 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

Pneumomediastinum is rare in children and adolescents, and its causes have not yet been clearly determined. We aimed to identify the causes, clinical manifestations and prognosis of noniatrogenic pneumomediastinum in children.

Methods

From February 2007 to June 2014, we retrospectively investigated 121 patients with pneumomediastinum under 18 years of age in 2 hospitals. Eighteen patients with pneumomediastinum after thoracotomy and 35 patients with iatrogenic pneumomediastinum were excluded.

Results

Sixty-eight patients were divided into 4 age groups: those under 1 year of age (n=9, 13.2%), those 1 to 5 years of age (n=9, 13.2%), those 6 to 10 years of age (n=17, 25.0%) and those over 11 years of age (n=33, 48.5%). Chest pain (n=43, 63.2%) was the most common initial complaint and subcutaneous emphysema was identified in 18 patients (26.5%). Chest x-ray was diagnostic in all except 9 patients (13.2%). Predisposing causes of pneumomediastinum were idiopathic (n=26, 38.2%), respiratory tract infection (n=23, 33.8%), asthma exacerbation (n=4, 5.9%), trauma (n=4, 5.9%), endobronchial foreign body (n=2, 2.9%), interstitial lung disease (n=5, 7.4%), and neonatal respiratory disease (n=4, 5.9%). Chest pain (P<0.001) and idiopathic cause (P=0.001) were shown to linearly increase with age. On the contrary, tachypnea (P<0.001), dyspnea (P=0.016), and interstitial lung disease (P=0.008) were shown to have a decreasing linear association with age. The length of hospital stay was significantly increased in patients with interstitial lung disease (P=0.042), those with pneumothorax (P=0.044), and those without chest pain (P=0.013).

Conclusion

According to age groups, there were significant differences in causes and clinical manifestations. In particular, pneumomediastinum that developed in younger patients with interstitial lung disease showed unfavorable outcomes, such as dyspnea, pneumothorax, and increased length of hospital stay. Therefore, precise evaluation of predisposing causes and careful management are needed for children with pneumomediastinum.

Keywords: Pneumomediastinum, Interstitial lung disease, Child

Figures and Tables

Fig. 1

Selection of the patients and classification by predisposing causes. ILD, interstitial lung disease. *ILD included humidifier disinfectant-associated children's interstitial lung disease (n=4) and idiopathic pulmonary fibrosis (n=1).

aard-3-145-g001
Table 1

General characteristics of the patients (n=68)

aard-3-145-i001
Characteristic Value
Age (yr) 9.9±6.3
 <1 9 (13.2)
 1-5 9 (13.2)
 6-10 17 (25.0)
 ≥11 33 (48.5)
Gender
 Male/female 51/17 (75.0/25.0)
Symptoms/signs
 Chest pain 43 (63.2)
 Dyspnea 30 (44.1)
 Tachypnea 28 (41.2)
 Subcutaneous emphysema 18 (26.5)
Diagnostic imaging modalities
 Chest x-ray 59 (86.8)
 Chest CT 33 (48.5)
Treatment modalities
 HHFNC 1 (1.5)
 Mechanical ventilator 16 (23.5)
 Thoracostomy 7 (10.3)
 Operation* 4 (5.9)
Prognosis
 Hospital stay (day) 15.0±30.6
 Accompanied pneumothorax 11 (16.2)
 Recurrence 10 (14.7)
 Death 3 (4.4)

Values are presented as mean±standard deviation or number (%).

HHFNC, humidified high-flow nasal cannula.

*Operation included heart and lung transplantation (n=1), bullectomy (n=1), and foreign body removal via ventilating bronchoscopy (n=2).

Table 2

Predisposing causes of pneumomediastinum

aard-3-145-i002
Variable No. of cases (%) Age (yr), mean ± SD Gender (M/F)
Idiopathic 26 (38.2) 14.0 ± 5.2 23/3
Respiratory infection 23 (33.8) 9.2 ± 4.2 18/5
Asthma exacerbation (noninfectious) 4 (5.9) 8.9 ± 4.9 3/1
Trauma 4 (5.9) 11.8 ± 3.3 4/0
Foreign body 2 (2.9) 1.3 ± 0.5 0/2
ILD 5 (7.4) 1.9 ± 2.9 1/4
Neonatal respiratory disease* 4 (5.9) - 2/2

SD, standard deviation; ILD, interstitial lung disease.

*All of these neonates were 1 day of age.

Table 3

Clinical differences of patients according to age

aard-3-145-i003
Variable < 1 yr (n = 9) 1-5 yr (n = 9) 6-10 yr (n = 17) ≥ 11 yr (n = 33) P-value†
Gender
 Male/female 5/4 (55.6/44.4) 4/5 (44.4/55.6) 13/4 (76.5/23.5) 29/4 (87.9/12.1) 0.008
Symptoms/signs
 Chest pain 0 (0) 2 (22.2) 12 (70.6) 29 (87.9) < 0.001
 Tachypnea 7 (77.8) 6 (66.7) 12 (70.6) 3 (9.1) < 0.001
 Dyspnea 4 (44.4) 7 (77.8) 12 (70.6) 7 (21.2) 0.016
 Subcutaneous emphysema 0 (0) 5 (55.6) 3 (17.6) 10 (30.3) 0.447
Predisposing causes
 Idiopathic 3 (33.3) 0 (0) 1 (5.9) 22 (66.7) 0.001
 Respiratory infection 0 (0) 4 (44.4) 12 (70.6) 7 (21.2) 0.906
 Asthma exacerbation (noninfectious) 0 (0) 1 (11.1) 1 (5.9) 2 (6.1) 0.825
 Trauma 0 (0) 0 (0) 2 (11.8) 2 (6.1) 0.503
 Foreign body 0 (0) 2 (22.2) 0 (0) 0 (0) 0.134
 ILD 2 (22.2) 2 (22.2) 1 (5.9) 0 (0) 0.008
 Neonatal respiratory disease 4 (44.4) 0 (0) 0 (0) 0 (0) < 0.001
Treatment modalities
 HHFNC 0 (0) 0 (0) 0 (0) 1 (3.0) 0.750
 Mechanical ventilator 6 (66.7) 6 (66.7) 3 (17.6) 1 (3.0) < 0.001
 Thoracostomy 4 (44.4) 2 (22.2) 1 (5.9) 0 (0) < 0.001
 Operation* 0 (0) 2 (22.2) 1 (5.9) 1 (3.0) 0.638
Prognosis
 Accompanied pneumothorax 5 (55.6) 2 (22.2) 2 (11.8) 2 (6.1) 0.001
 Recurrence 2 (22.2) 3 (33.3) 2 (11.8) 3 (9.1) 0.151
 Death 1 (11.1) 2 (22.2) 0 (0) 0 (0) 0.027

Values are presented as number (%).

ILD, interstitial lung disease; HHFNC, humidified high-flow nasal cannula.

*Operation included heart and lung transplantation (n=1), bullectomy (n=1), and foreign body removal via ventilating bronchoscopy (n=2). †Linear by linear association.

Table 4

Comparisons of length of hospital stay by sex, predisposing causes, symptoms/signs, and complication

aard-3-145-i004
Variable Length of stay (day), mean ± SD P-value*
Gender
 Male/female 13.4 ± 32.0/19.7 ± 25.9 0.466
Predisposing causes
 Idiopathic/secondary 12.4 ± 36.5/16.6 ± 26.6 0.579
 Respiratory infection/non 8.5 ± 4.8/18.3 ± 37.1 0.089
 Asthma exacerbation (noninfectious)/non 10.5 ± 8.4/15.3 ± 31.4 0.765
 Trauma/non 5.0 ± 4.8/15.6 ± 31.4 0.505
 Foreign body/non 8.5 ± 0.7/15.2 ± 31.0 0.763
 ILD/non 73.6 ± 48.2/10.3 ± 23.7 0.042
 Neonatal respiratory disease/non 13.8 ± 8.6/15.1 ± 31.5 0.934
Symptoms/signs
 Chest pain/non 5.8 ± 3.4/30.8 ± 46.6 0.013
 Tachypnea/non 22.5 ± 32.4/10.3 ± 28.7 0.109
 Dyspnea/non 21.3 ± 37.8/10.0 ± 22.6 0.155
 Subcutaneous emphysema/non 14.7 ± 21.2/15.1 ± 33.5 0.966
Complication
 Pneumothorax/non 51.2 ± 62.3/8.0 ± 10.8 0.044

SD, standard deviation; ILD, interstitial lung disease.

*Student t-test.

Notes

This study was supported by academic research fund for free assignment of Pusan National University.

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