Thoracic Surgery Department, Hospital de Navarra, Pamplona, Spain.
Eur J Cardiothorac Surg. 2010 Mar;37(3):573-5. doi: 10.1016/j.ejcts.2009.08.002. Epub 2009 Sep 12.
Spontaneous pneumomediastinum is uncommon and is traditionally considered a benign, self-limited disorder that usually occurs in young adults without any apparent precipitating factor or disease. The purpose of this study is to present 47 new cases because of their different clinical behaviours.
A descriptive, retrospective case series was conducted to identify adult patients with spontaneous pneumomediastinum who were diagnosed and treated in a single institution between 2000 and 2008.
Forty-seven patients were identified, including 33 men and 14 women with a mean age of 27.3 years (range, 16-42 years). Acute-onset chest pain was the predominant symptom at presentation (59.5%); subcutaneous emphysema was the most common sign (42.9%). The most common predisposing factor was consumption of illegal drug (cocaine): it was not a regular and long-term abuse but an occasional trend, coinciding few hours before presenting symptoms (55%). Notably, in one case, a bad outcome with mediastinal shift and important tracheal compression necessitated a right thoracotomy to open the mediastinal pleura.
(1) It is known that occasional consumption of cocaine causes diffuse alveolar damage, haemorrhage, etc. The cause-effect relationship consumption-appearance in a few hours of spontaneous pneumomediastinum leads us to appreciate this form of consumption as a causal factor rather than a predisposing/precipitating factor as it appears in the literature on the topic. (2) Spontaneous pneumomediastinum is considered a benign disorder but, as shown by our series, a bad outcome may represent an immediate life-threatening condition, forcing an invasive manoeuvre. We always recommend performing a chest CT scan on admission to predict the evolution.
自发性纵隔气肿并不常见，传统上被认为是一种良性、自限性疾病，通常发生在没有明显诱发因素或疾病的年轻成年人中。本研究的目的是报告 47 例新病例，因为它们具有不同的临床表现。
采用描述性、回顾性病例系列研究，在 2000 年至 2008 年间，在一家机构中对诊断为自发性纵隔气肿的成年患者进行了识别。
共发现 47 例患者，包括 33 名男性和 14 名女性，平均年龄为 27.3 岁（范围为 16-42 岁）。急性发作的胸痛是主要的首发症状（59.5%）；皮下气肿是最常见的体征（42.9%）。最常见的诱发因素是使用非法药物（可卡因）：这不是一种常规和长期的滥用，而是一种偶尔的趋势，与出现症状前的几个小时巧合（55%）。值得注意的是，在一例病例中，纵隔移位和重要的气管压迫导致不良预后，需要进行右开胸术打开纵隔胸膜。
（1）众所周知，偶尔使用可卡因会导致弥漫性肺泡损伤、出血等。在几个小时内出现自发性纵隔气肿的因果关系促使我们将这种使用方式视为一个因果因素，而不是文献中提到的诱发/促成因素。（2）自发性纵隔气肿被认为是一种良性疾病，但正如我们的系列研究所示，不良预后可能代表立即危及生命的情况，需要进行有创操作。我们总是建议在入院时进行胸部 CT 扫描，以预测疾病的进展。
