Disposition of spontaneous pneumomediastinum.

In the evaluation of spontaneous pneumomediastinum, it is important to exclude pathological causes of pneumomediastinum, including Boerhaave's syndrome, which carries a high mortality rate. The literature varies greatly as to the care of patients with presumed spontaneous pneumomediastinum. The authors present an illustrative case of spontaneous pneumomediastinum treated with intravenous antibiotics and intensive care unit (ICU) admission despite a normal esophagram. Spontaneous pneumomediastinum is a benign entity that may not require observation in an ICU, and patients may do as well with close outpatient follow-up. For those patients in which the etiology of the pneumomediastinum is unclear, a contrast esophagram is recommended to assess for esophageal disruption. The signs, symptoms, pathophysiology, and disposition of spontaneous pneumomediastinum are discussed.