[Spontaneous pneumomediastinum: clinic, diagnostics and treatment].

Spontaneous pneumomediastinum (SPM) is an uncommon, benign, self-limited disorder that usually occurs in young adults without any apparent precipitating factor or disease. The purpose of this study was to review our experience in dealing with this entity and detail a reasonable course of assessment and management. A retrospective case series of 4 patients with SPM were diagnosed and treated in a Thoraci Surgery Department at Saint Sofia Pulmonary Hospital between 2000 and 2006. The patiets' group included 3 male and 1 female with a mean age of 17.5 years (between 15 and 21). Acute onset chest pain was the predominant symptom at presentation. All of the patients developed clinically evident subcutaneous emphysema. Chest radiography and computerized tomography (CT) were diagnostic in all cases. Esophagogram and flexible bronchoscopy were used in all cases as well. All 4 patients were admitted to the hospital. Their mean hospital stay was 1.5 (between 1 and 2) days. All patients were conservatively treated. In a follow-up of 1-6 years no complications or recurrences were observed. In conclusion, SPM follows alveolar rupture in the pulmonary interstitium. It has a wide range of clinical features necessitating a high index of suspicion. Chest X-ray and CT scan should be always performed. Hospitalization and aggressive approach should be limited. SPM responds well to conservative treatment and follows a benign natural course.