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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/07/25 11:02:27」(JST)

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Pneumomediastinum (from Greek pneuma - "air", also known as mediastinal emphysema) is a condition in which air is present 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

Look up pneumomediastinum in Wiktionary, the free dictionary.

00964 at CHORUS

UpToDate Contents

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1. 小児および思春期における自然縦隔気腫 spontaneous pneumomediastinum in children and adolescents
2. 機械的人工換気中の肺気圧障害 pulmonary barotrauma during mechanical ventilation
3. 成人患者における外傷性胃腸障害 traumatic gastrointestinal injury in the adult patient
4. コカイン乱用の肺合併症 pulmonary complications of cocaine abuse
5. 新生児における肺のエアリーク pulmonary air leak in the newborn

English Journal

An unusual etiology of abdominal pain and spontaneous pneumomediastinum in a young adult.

Sun D, Chen F, Wang C.
The American journal of emergency medicine.Am J Emerg Med.2014 Aug;32(8):947.e1-2. doi: 10.1016/j.ajem.2014.01.035. Epub 2014 Jan 30.
PMID 24602893

Extensive subcutaneous emphysema complicating a percutaneous Mumford procedure.

Saseendar S1, Tan SH, Vijayan S, Pawaskar A, Kumar VP.
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA.Knee Surg Sports Traumatol Arthrosc.2014 Jul 25. [Epub ahead of print]
Subcutaneous emphysema may be a part of a life-threatening pneumomediastinum or pneumothorax and usually does not occur alone. A case of a 75-year-old lady who underwent a percutaneous Mumford procedure for acromioclavicular osteoarthrosis has been reported. She developed extensive subcutaneous emph
PMID 25059337

Air Compressor-Induced Pneumocephalus, Pneumomediastinum, and Extensive Emphysema.

Erdem Y1, Karatay M, Sertbaş I, Celik H, Bayar MA.
Pediatric neurosurgery.Pediatr Neurosurg.2014 Jul 15. [Epub ahead of print]
PMID 25033842

Japanese Journal

症例嚥下痛を伴った特発性縦隔気腫の1例

藤原清宏,伊藤武文,寺本佳奈子 [他]
内科 114(1), 170-172, 2014-07
NAID 40020137846

臨床研究・症例報告特発性縦隔気腫の2女児例

金井宏明,光田栄子,佐藤広樹 [他]
小児科臨床 67(7), 1207-1211, 2014-07
NAID 40020094231

ICU・CCU : あんな症例,こんな症例(第25回)人工呼吸管理に伴う気胸および縦隔気腫に合併した気腹症の1例

岡本彩那,坂田寛之,松田健一 [他]
ICUとCCU = Japanese journal of intensive care medicine : 集中治療医学 38(4), 282-284, 2014-04
NAID 40020115926

Related Pictures

★リンクテーブル★

リンク元	「縦隔気腫」「気縦隔」「気縦隔症」

「縦隔気腫」

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

　　[★]

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

「気縦隔」

　　[★]

英: pneumomediastinum
関: 縦隔気腫、気縦隔症

「気縦隔症」

　　[★]

英: pneumomediastinum
関: 気縦隔、縦隔気腫

[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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pneumomediastinum