[Etiology and treatment of non-thoracotraumatic pneumomediastinum].

OBJECTIVE

To investigate the etiological factors, pathogenesis, and treatment of pneumomediastinum not caused by thoracic injury and chest operation.

METHODS

56 patients with non-thoracotraumatic pneumomediastinum were divided into 3 groups according to etiology: idiopathic pneumomediastinum (n = 37), descending pneumomediastinum (n = 11) and ascending pneumomediastinum (n = 8). All of 56 patients received symptomatic treatment by mediastinotomy and etiological treatment on the basis of different primary affection of mouth, throat, neck, bronchus, colon etc.

RESULTS

Complete recovery was observed in 45 patients and partial recovery was found in 5 patients. The causes of death in 6 patients were serious pulmonary infection with respiratory failure, descending necrotizing mediastinitis with multi-organ failure and colonic perforation with septicopyemia.

CONCLUSION

Most non-thoracotraumatic pneumomediastinum are secondary to the underlying diseases, the mechanisms of its pathogenesis include lung interstitium path (idiopathic), oropharyngeal and cervical interspace path (descending), and extraperitoneal space path (ascending). The treatment should be focused on dealing with primary diseases as well as symptomatic treatment by mediastinotomy.