Lee Chia-Ying, Wu Chou-Chieh, Lin Ching-Yuang
Department of Pediatrics, Children's Medical Center, China Medical University Hospital, Taichung, Taiwan.
Pediatr Neonatol. 2009 Oct;50(5):190-5. doi: 10.1016/S1875-9572(09)60062-0.
Spontaneous pneumomediastinum (SPM), while rare, is probably underestimated in children. Treatments for SPM target the underlying disease and trigger factors. This study aimed to analyze the etiology of SPM in different age groups.
A total of 18 children with SPM were analyzed in the Children's Medical Center at China Medical University Hospital between 1997 and 2007.
The incidence of SPM in children was 1:8,302 patients at the Department of Pediatric Emergency Medicine. A bimodal peak in incidence occurred in those younger than 4 years old and in those aged 15-18 years. Characteristic symptoms were dyspnea (77.8%), followed by chest pain (66.7%) and neck pain (44.4%); common specific physical signs were subcutaneous emphysema (55.6%) and Hammer's sign (11.1%). Trigger factors were infection (44.4%), with a mean age of 5.8+5.0 years, and diabetic ketoacidosis (5.6%), with a mean age of 18 years. Idiopathic SPM accounted for 50.0% of patients, with mean age 14.4 +/- 1.8 years. In terms of the age distribution, five (27.8%; males/females=4:1) preschoolers (<6 years old) developed SPM, mostly due to infectious disease. Two girls aged less than 10 years developed asthma in later years. All eight male adolescents (> or =10 years) developed SPM due to idiopathic factors. Of nine boys with idiopathic SPM, six underwent strenuous exercise before developing SPM. Mean hospitalization was 7.9 +/- 11.5 days and 11 (61.1%) patients needed intensive care. Nearly all of the patients had complete resolution on chest radiography before discharge.
Clinicians should be alert to the risk of SPM based on the presence of these symptoms. The etiology of SPM varies with age. Treatment of SPM must target the trigger factors or the underlying disease.
自发性纵隔气肿（SPM）虽罕见，但在儿童中可能被低估。SPM的治疗针对潜在疾病和触发因素。本研究旨在分析不同年龄组SPM的病因。
1997年至2007年期间，在中国医科大学附属儿童医院对18例SPM患儿进行了分析。
在儿科急诊科，儿童SPM的发病率为1:8302。发病率有两个高峰，分别出现在4岁以下儿童和15 - 18岁青少年中。特征性症状为呼吸困难（77.8%），其次是胸痛（66.7%）和颈部疼痛（44.4%）；常见的特异性体征为皮下气肿（55.6%）和哈默氏征（11.1%）。触发因素为感染（44.4%），平均年龄为5.8±5.0岁，以及糖尿病酮症酸中毒（5.6%），平均年龄为18岁。特发性SPM占患者的50.0%，平均年龄为14.4±1.8岁。在年龄分布方面，5名（27.8%；男/女 = 4:1）学龄前儿童（<6岁）发生SPM，主要原因是传染病。两名10岁以下女孩后来患哮喘。所有8名男性青少年（≥10岁）因特发性因素发生SPM。在9例特发性SPM男孩中，6例在发生SPM前进行了剧烈运动。平均住院时间为7.9±11.5天，11例（61.1%）患者需要重症监护。几乎所有患者出院前胸部X线检查均完全恢复。
临床医生应根据这些症状警惕SPM的风险。SPM的病因随年龄而异。SPM的治疗必须针对触发因素或潜在疾病。
