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an abnormal condition of the lungs marked by decreased respiratory function; associated with smoking or chronic bronchitis or old age (同)pulmonary_emphysema

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気腫(きしゅ),肺気腫

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/09/18 04:55:51」(JST)

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Pneumomediastinum (from Greek pneuma - "air", also known as mediastinal emphysema) is pneumatosis (abnormal presence of air or other gas) in the mediastinum. First described in 1819 by René Laennec,^[1]^[2] the condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways, or bowel into the chest cavity.

Presentation

Pneumomediastinum and right sided pneumothorax post first rib fracture in a mountain biking accident.

Pneumomediastinum is uncommon and occurs when air leaks into the mediastinum. The diagnosis can be confirmed via chest X-ray showing a radiolucent outline around the heart and mediastinum or via CT scanning of the thorax.

Etiology

It is most commonly caused by:

Oesophageal rupture, for example in Boerhaave syndrome
Asthma or other conditions leading to alveolar rupture
Bowel rupture, where air in the abdominal cavity tracts up into the chest.

It has also been associated with:

Mycoplasma pneumoniae pneumonia^[3]
obesity^[4]

It can be induced to assist thoracoscopic surgery.^[5] It can be caused by a pulmonary barotrauma resulting when a person moves to or from a higher pressure environment, such as when a SCUBA diver,^[6]^[7] a free-diver^[8] or an airplane passenger^[9] ascends or descends.

In rare cases, pneumomediastinum may also arise as a result of blunt chest trauma (e.g. car accidents, fights, over pressure of breathing apparatus), while still evolving in the same fashion as the spontaneous form.^[10]

Pneumomediastinum is most commonly seen in otherwise healthy young male patients and may not be prefaced by a relevant medical history of similar ailments.^[11]

Signs and Symptoms

The main symptom is usually severe central chest pain. Other symptoms include laboured breathing, voice distortion (as with helium) and subcutaneous emphysema, specifically affecting the face, neck, and chest.^[12] Pneumomediastinum can also be characterized by the shortness of breath that is typical of a respiratory system problem. It is often recognized on auscultation by a "crunching" sound timed with the cardiac cycle (Hamman's crunch). Pnemomediastinum may also present with symptoms mimicking cardiac tamponade as a result of the increased intrapulmonary pressure on venous flow to the heart ^[13]

Pneumomediastinum with Angel wing sign

Treatment

The tissues in the mediastinum will slowly resorb the air in the cavity so most pneumomediastinums are treated conservatively. Breathing high flow oxygen will increase the absorption of the air. If the air is under pressure and compressing the heart, a needle may be inserted into the cavity, releasing the air. Surgery may be needed to repair the hole in the trachea, esophagus or bowel.

If there is lung collapse, it is imperative the affected individual lies on the side of the collapse, although painful, this allows full inflation of the unaffected lung.

References

^ Laënnec RTH. De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumon et du Coeur. 1st ed. Paris: Brosson & Chaudé; 1819.
^ Roguin A (2006). "Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope". Clinical medicine & research. 4 (3): 230–5. doi:10.3121/cmr.4.3.230. PMC 1570491. PMID 17048358.
^ Vázquez JL, Vázquez I, González ML, García-Tejedor JL, Repáraz A (2007). "Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia". Pediatric Radiology. 37 (12): 1286–8. doi:10.1007/s00247-007-0611-1. PMID 17899058.
^ Hatzitolios A, Ntaios G (2007). "Spontaneous Pneumomediastinum May Be Associated with Both Anorexia Nervosa and Obesity". Lung. 185 (6): 373. doi:10.1007/s00408-007-9037-7. PMID 17909893.
^ Utsumi T, Shiono H, Fukai I, Akashi A (2007). "Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum". Interactive cardiovascular and thoracic surgery. 6 (3): 411–2. doi:10.1510/icvts.2006.147355. PMID 17669882.
^ Tetzlaff K, Reuter M (1998). "Recurrent pulmonary barotrauma (PBT) in a previously healthy male scuba diver who suffered from repeated pneumomediastinum after shallow-water scuba dives". Undersea Hyperb Med. 25 (2): 127–8. PMID 9670439. Retrieved 2008-06-05.
^ Dr. Richard Moon, Diver's Alert Network Vice President and Medical Director, http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=40
^ Jacobson FL, Loring SH, Ferrigno M (2006). "Pneumomediastinum after lung packing". Undersea Hyperb Med. 33 (5): 313–6. PMID 17091828. Retrieved 2008-06-05.
^ Nicol E, Davies G, Jayakumar P, Green ND (April 2007). "Pneumopericardium and pneumomediastinum in a passenger on a commercial flight". Aviat Space Environ Med. 78 (4): 435–9. PMID 17484349. Retrieved 2008-06-05.
^ Yellin A, Gapany-Gapanavicius M, Lieberman Y (1983). "Spontaneous Pneumomedistinum: Is It a Rare Cause of Chest Pain?". Thorax 38:383-385.
^ Cicak B, Verona E, Mihatov-Stefanovic I, Vrsalovic R (2009). "Spontaneous Pneumomediastinum in a Healthy Adolescent". Acta Clinica Croatica 48(4):461-7.
^ Quresi SA, Tilyard A (2008). "Unusual Presentation of Spontaneous Mediastinum: A Case Report". Cases Journal 1:349. doi:10.1186/1757-1626-1-349.
^ Beg MH, Reyazuddin, Ansari MM (1988). "Traumatic tension Pneumomediastinum Mimicking Cardiac Tamponade". Thorax 43:576-677. doi: 10.1136/thx.43.7.576.

External links

00964 at CHORUS

Pneumomediastinum Radiology from MedPix

UpToDate Contents

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1. 小児や青年の自然縦隔気腫 spontaneous pneumomediastinum in children and adolescents
2. 成人への侵襲的人工呼吸療法に伴う肺圧損傷の診断、マネージメント、予防 diagnosis management and prevention of pulmonary barotrauma during invasive mechanical ventilation in adults
3. 消化管穿孔の概要 overview of gastrointestinal tract perforation
4. ドラッグを注射している患者における肺疾患の概要 overview of pulmonary disease in injection drug users
5. 新生児における肺のエアリーク pulmonary air leak in the newborn

English Journal

Cervical Subcutaneous Emphysema and Pneumomediastinum After Septorhinoplasty.

Kim ES1, Kang JW, Kim CH, Hong JM.Author information 1From the Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.AbstractCervical and facial subcutaneous emphysema is mainly caused by maxillofacial trauma or head and neck surgery. There are only 2 cases of subcutaneous emphysema after septorhinoplasty in the English literature. We report a case of subcutaneous emphysema and pneumomediastinum after a septorhinoplasty.A healthy 35-year-old man with nasal obstruction and dissatisfaction with the shape of his nose was referred to our outpatient clinic. The patient had a septorhinoplasty including bilateral medial and lateral osteotomy under general anesthesia. On the fifth day after the surgery, the patient visited the emergency department with swelling and pain in the right submandibular area and cheek. On computed tomographic (CT) scans, air was observed in the right temporal space, masticator space, submandibular space, and superior mediastinal space. He was immediately hospitalized for administration of intravenous antibiotics and bed rest.On the fifth day after the hospitalization, follow-up CT scans were performed. Subcutaneous emphysema and pneumomediastinum were markedly decreased. The patient was discharged on the fifth day.
The Journal of craniofacial surgery.J Craniofac Surg.2014 Feb 26. [Epub ahead of print]
Cervical and facial subcutaneous emphysema is mainly caused by maxillofacial trauma or head and neck surgery. There are only 2 cases of subcutaneous emphysema after septorhinoplasty in the English literature. We report a case of subcutaneous emphysema and pneumomediastinum after a septorhinoplasty.A
PMID 24577299

Impact of steroid medication before hospital admission on barotrauma in mechanically ventilated patients with acute respiratory distress syndrome in intensive care units.

Umegaki T1, Sakamoto S, Nishi K, Okamoto A, Onose A, Hamano N, Yamazaki E, Shingu K.Author information 1Department of General Intensive Care Unit, Hirakata Hospital, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan, umegakit@hirakata.kmu.ac.jp.AbstractPURPOSE: To investigate the association between steroid medication before hospital admission and barotrauma in mechanically ventilated patients with acute respiratory distress syndrome (ARDS).
Journal of anesthesia.J Anesth.2014 Feb 20. [Epub ahead of print]
PURPOSE: To investigate the association between steroid medication before hospital admission and barotrauma in mechanically ventilated patients with acute respiratory distress syndrome (ARDS).METHODS: An observational single-center retrospective study was conducted using patients admitted to the gen
PMID 24554247

Japanese Journal

症例歯科処置を契機に発症した縦隔気腫の1例

水橋啓一
日本職業・災害医学会会誌 = Japanese journal of occupational medicine and traumatology 61(6), 404-408, 2013-11
NAID 40019888511

BEP(Bleomycin, Etoposide, Cisplatin)療法施行中に縦隔気腫を発症した精巣癌の1例

野口剛,太田純一,石垣華子 [他],小貫竜昭,加藤善健,森山正敏
泌尿器科紀要 = Acta urologica Japonica 59(8), 545-549, 2013-08
… On day 13 of the fourth course of BEP, he complained of snowball crepitation of the neck and computed tomography revealed subcutaneous emphysema, extensive mediastinal air, and intraspinal air accumulation without pneumothorax. … The pneumomediastinum and subcutaneous emphysema tended to deteriorate until 15 days after the onset of pneumomediastinum, but fortunately he had no signs or symptoms of infection. …
NAID 120005322749

Related Pictures

★リンクテーブル★

リンク元	「縦隔気腫」
関連記事	「emphysema」「mediastinal」

「縦隔気腫」

Pneumomediastinum
	A CT scan showing air in the mediastinum
Classification and external resources
Specialty	pediatrics
ICD-10	J98.2, P25.2
ICD-9-CM	518.1, 770.2
DiseasesDB	29460
MedlinePlus	000084
eMedicine	ped/1832 emerg/469
MeSH	D008478
	[edit on Wikidata]

　　[★]

英: mediastinal emphysema
ラ: emphysema mediastinales
同: 気縦隔気縦隔症 pneumomediastinum

「emphysema」

　　[★]

n.

ORIGIN mid 17th cent. (sense 2) : via late Latin from Greek emphusēma, from emphusan ‘puff up.’

puff upは'息を切らす'

「mediastinal」

　　[★]

adj.

縦隔の、縦隔洞の

関: mediastinum

[1] Laënnec RTH. De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumon et du Coeur. 1st ed. Paris: Brosson & Chaudé; 1819.

[pmid17048358-2] Roguin A (2006). "Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope". Clinical medicine & research. 4 (3): 230–5. doi:10.3121/cmr.4.3.230. PMC 1570491. PMID 17048358.

[pmid17899058-3] Vázquez JL, Vázquez I, González ML, García-Tejedor JL, Repáraz A (2007). "Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia". Pediatric Radiology. 37 (12): 1286–8. doi:10.1007/s00247-007-0611-1. PMID 17899058.

[pmid17909893-4] Hatzitolios A, Ntaios G (2007). "Spontaneous Pneumomediastinum May Be Associated with Both Anorexia Nervosa and Obesity". Lung. 185 (6): 373. doi:10.1007/s00408-007-9037-7. PMID 17909893.

[pmid17669882-5] Utsumi T, Shiono H, Fukai I, Akashi A (2007). "Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum". Interactive cardiovascular and thoracic surgery. 6 (3): 411–2. doi:10.1510/icvts.2006.147355. PMID 17669882.

[6] Tetzlaff K, Reuter M (1998). "Recurrent pulmonary barotrauma (PBT) in a previously healthy male scuba diver who suffered from repeated pneumomediastinum after shallow-water scuba dives". Undersea Hyperb Med. 25 (2): 127–8. PMID 9670439. Retrieved 2008-06-05.

[7] Dr. Richard Moon, Diver's Alert Network Vice President and Medical Director, http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=40

[8] Jacobson FL, Loring SH, Ferrigno M (2006). "Pneumomediastinum after lung packing". Undersea Hyperb Med. 33 (5): 313–6. PMID 17091828. Retrieved 2008-06-05.

[9] Nicol E, Davies G, Jayakumar P, Green ND (April 2007). "Pneumopericardium and pneumomediastinum in a passenger on a commercial flight". Aviat Space Environ Med. 78 (4): 435–9. PMID 17484349. Retrieved 2008-06-05.

[10] Yellin A, Gapany-Gapanavicius M, Lieberman Y (1983). "Spontaneous Pneumomedistinum: Is It a Rare Cause of Chest Pain?". Thorax 38:383-385.

[11] Cicak B, Verona E, Mihatov-Stefanovic I, Vrsalovic R (2009). "Spontaneous Pneumomediastinum in a Healthy Adolescent". Acta Clinica Croatica 48(4):461-7.

[12] Quresi SA, Tilyard A (2008). "Unusual Presentation of Spontaneous Mediastinum: A Case Report". Cases Journal 1:349. doi:10.1186/1757-1626-1-349.

[13] Beg MH, Reyazuddin, Ansari MM (1988). "Traumatic tension Pneumomediastinum Mimicking Cardiac Tamponade". Thorax 43:576-677. doi: 10.1136/thx.43.7.576.

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案内

mediastinal emphysema