Think about where the air came from
History taking :
Hx of Severe Vomiting, Coughing,
Valsalva maneuver, inhalation of toxic fumes,
Valsalva maneuver, inhalation of toxic fumes,
Scuba diving, mechanical ventilation
Underlying lung condition :
COPD/Asthma, interstitial lung, malignancy ...
COPD/Asthma, interstitial lung, malignancy ...
Pneumomediastinum in blunt chest trauma
is most commonly the result of alveolar rupture,
is most commonly the result of alveolar rupture,
followed by dissection along the bronchoalveolar sheath
and subsequent spread of air to the mediastinum
and subsequent spread of air to the mediastinum
Need to excluded :
Foreign body ingestion, PTX, Hallow organ perforation
Trauma to airway, esophagus …
Esophageal rupture
Esophageal rupture
Severe and rare Complication :
Tamponade (Tension pneumomediastinum or pneumopericardium)
Treatment to exclude esignificant pathology first,
then symptomatic treatment :
Bed rest, Pain controlled, cough and Vomiting treatment, O2
Bed rest, Pain controlled, cough and Vomiting treatment, O2
Observation 24 hr if non complicated Pneumomediastinum
* 一般外傷 或 iatrogenic 造成很合理
* Spontaneous pneumomediastinum :
氣主要來自咽喉, 氣管或食道
大部分是因為胸內壓上升導致氣體跑到縱膈腔軟組織
常見導致胸內壓上升的原因
過度或用力咳嗽, 打噴嚏, 嘔吐, 潛水
搭飛機導致氣壓改變, 運動(如籃球或足球等)
氣喘等疾病及不明原因
* 治療原則 :
大部分病患在 3-7天左右自行恢復
急診留觀或住院觀察目的在於排除其他原因
若症狀及影像追蹤無改善，需要安排進一步檢查
如 : 胸部電腦斷層、食道攝影、食道胃鏡 …
預後: 自發性氣縱膈的兩年內復發機率低, 建議門診追蹤治療
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