Author(s): Ketaki Vasudeo Utpat, Shailesh Kolekar, Jyotsna Madanmohan Joshi

BACKGROUND Pneumomediastinum is a rare condition with diverse aetiologies which is defined by presence of air in the mediastinum. We performed a retrospective analysis of 15 patients with pneumomediastinum. The purpose of our study was to report our experience in the management of pneumomediastinum of varied aetiologies. MATERIALS AND METHODS Patients who were diagnosed to have pneumomediastinum on chest radiograph between 1991 to 2001 were included in the study. The presence of associated subcutaneous emphysema was noted. History combined with appropriate investigations to establish the etiology. No specific treatment was given for subcutaneous emphysema. Patients who had associated pneumothorax had intercostal tube drainage while the rest were managed conservatively. The treatment outcome was analysed. RESULTS Of the 15 cases of pneumomediastinum, age groups ranging from 14 to 70 years there were 13 males and 2 females. 9 patients presented with subcutaneous emphysema and 8 had associated pneumothorax. Pneumomediastinum was spontaneous in 10 cases, following blunt trauma in 3, post tracheostomy and oesophagoscopy in 1 patient each. Intercostal drains (ICD) were inserted in 8, as there was an associated pneumothorax, whereas 7 patients were treated conservatively. The average duration of drain was 11.6 days while there was spontaneous resolution of pneumomediastinum by the 5th day in the conservatively treated patients without pneumothorax. 2 patients succumbed, one patient being case of traumatic pneumothorax due to associated lung contusion and the other was a case of complications related to pulmonary tuberculosis and human immunodeficiency virus co-infection. CONCLUSIONS Pneumomediastinum should be managed conservatively irrespective of subcutaneous emphysema and intercostal drainage must be instituted only when there is an associated pneumothorax.