Pneumomediastinum, also known as mediastinal emphysema, is a condition in which air is present in the mediastinum the space in the chest between the two lungs. Pneumomediastinum in the newborn, occurring without pneumothorax, is a rare condition. Clinical history and examination of the neonate may be uninformative in determining the aetiology of the respiratory. On day 11, a chest xray was performed to confirm position of a peripherally inserted longline. Transillurmination of the neonatal chest is described as an aid in the diagnosis of pneumothorax or pneumomediastinum. Pneumomediastinum from greek pneuma air, also known as mediastinal emphysema is pneumatosis abnormal presence of air or other gas in the mediastinum. After alveolar rupture air diffuses towards the perivascular and. Pneumothorax and pneumomediastinum in newborndreadful complications of barotrauma and rare cause of cardiac tamponade.
Spontaneous pneumomediastinum in a term neonate case report. Value of routine radiographic examinations of newborn based on study of seven hundred and two consecutive values. The clinical course of pulmonary interstitial emphysema pie, pneumomediastinum pm, and pneumothorax pt was studied in 57 premature and 20 fullterm newborn infants. Relationtoothermediastinal structures localizes thesegascollections totheinfraazygous region,andthemidlinelocation distinguishes infraazygous pneu. Most spontaneous pneumomediastinum in neonates is associated with birth injury, prematurity, pneumonia. Spontaneous multiseptated cystic pneumomediastinum in a. When pneumomediastinum occurs in the newborn, it is most commonly due to congenital anomalies of the tracheobronchial tree or to excessive intraalveolar pressure during attempts at resuscitation. Spontaneous pneumomediastinum in children and adolescents. Spontaneous multiseptated cystic pneumomediastinum in a term newborn.
Spontaneous pneumomediastinum associated with subcutaneous. Pneumomediastinum is an uncommon entity in pediatric practice. Spontaneous pneumomediastinum in the term newborn is relatively rare. Pneumomediastinum in the newborn report of a case 1 eugene j.
The constellation of symptoms and signs such as respiratory distress, cervical subcutaneous emphysema, pneumomediastinum with or without a pneumothorax, a fractured clavicle, or an erb palsy in. Its radiographic appearance on anteroposterior films of the supine infant may be confused with pneumomediastinum or pneumothorax so that knowledge of the relevant fascial layers is necessary for an understanding of the pathophysiology and allows proper radiographic. When it occurs, it is often associated with asthma. Doctors believe its caused by a difference in pressure between the air sacs the alveoli. Common causes include transient tachypnoea of the newborn, respiratory distress syndrome, pneumothorax, meconium aspiration syndrome and pneumonia. Excerpt pneumomediastinum in the newborn, occurring without pneumothorax, is a rare condition. This condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways or bowel into the chest cavity. Spontaneous pneumomediastinum in term neonates is also rarely reported. Neonatal pneumomediastinum occurs in approximately 2.
Our knowledge of pm is insufficient,and its management is mainly based on the best practice and experience of each hospital rather thanon evidencebased data. Pneumomediastinum in the newborn infant the journal of pediatrics. The neonate whose pneumothorax represents our third miss was a 1. Pneumomediastinum pm was first described by laennec in 1819 as a consequence of traumatic injury. Pulmonary interstitial emphysema, pneumomediastinum, and. The thymic lobe configuration and the importance of the lateral projection in the diagnosis of loculated pneumomediastinum in the newborn are illustrated by the following case.
We present an otherwise healthy 4hourold male, born by a caesarean section, presenting with sudden bulging of the left hemithorax and moderate respiratory distress. Spontaneous pneumomediastinum in a term neonate case. Pneumomediastinum after birth, without birth injury or resuscitation maneuvers, is an unusual situation that can present with grunting. Gumbiner and cutler 2 reported several cases and were able to collect 8 additional examples from the literature. Pneumothorax and pneumomediastinum in newborndreadful. It is defined as free air or gas contained within the mediastinum. This can be caused by a traumatic injury or in association with pneumothorax or other diseases. Fort wayne, indiana in the past few decades, a great deal has been learned concerning the newborn who is dyspneic and in respiratory and circulatory distress. Gas may originate from the lungs, trachea, central bronchi, esophagus, and peritoneal cavity and track from the mediastinum to the neck or abdomen. It has been stated that more than one third of all deaths of infants occur during the first two weeks of life. Awareness of spontaneous pneumomediastinum in newborn babies with respiratory distress helps to direct. More than one hundred years later, in 1939, hamman, for the first time, reported a spontaneous pneumomediastinum.
Few symptoms are the source of more concern to the pediatrician than dyspnea and cyanosis in the newborn infant. In 1853, 2 cases of mediastinal emphysema of the newborn were recognized postmortem 1. Pneumomediastinum in the neonatal and paediatric intensive care unit. Pneumomediastinum pm is defined as a mediastinal air leak. Pneumomediastinum is a rare situation and occurs when air leaks into the mediastinum. Its diagnosis is usually followed by admission of the infant to a neonatal care unit for treatment and monitoring. Pneumomediastinum kouritas journal of thoracic disease. Spontaneous pneumomediastinum in otherwise healthy term newborns is rare and underdeveloped alveoli have been incriminated for its development. Neonatal pneumomediastinum can be confused with surgical cystic radiolucent mass owing to the unique anatomical feature of the neonatal thymus characterized by a thick enveloping fascial capsule that contains air. According to the results of a study in 1971 by steele rw and coworkers, in which chest films were obtained within two hours after birth in 300 routine vaginal deliveries, 100 premature infants, 100 infants born by cesarean section, and 50 intubated infants, the incidence of pneumomediastinum was. In either event it is considered that increased pulmonary intraalveolar pressure results in the extension of air along the perivascular spaces of the lung into. The underlying mechanism is alveolar rupture with leakage of air into the lung interstitium and dissection of that gas into the hilum and subsequently the mediastinum.
The results suggest that pie, pm, and pt represent a continuum of a single process. Sudden severe tension pneumothorax or pneumomediastinum can be localized for immediate treatment and the success of therapy can be immediately assessed using transillumination. Pulmonary ligament airnowbilateral and has bibbed configuration. Most cases of pneumomediastinum occur in preterm newborns with surfactant deficiency receiving treatment with positive pressure ventilation. This is a basic article for medical students and other nonradiologists pneumomediastinum describes airgas within the mediastinum and is readily demonstrated on ct and may be seen on a chest radiograph. We aim to emphasize the significance of radiographic and ct features of spontaneous pneumomediastinum. In the neonate, pneumomediastinum may be asymptomatic but may also cause significant respiratory distress.
Spontaneous pneumomediastinum in newborns is a rarely seen condition and, usually seen in the pres ence of any other underlying lung disease or assisted ventilation. Pdf spontaneous multiseptated cystic pneumomediastinum in a. May 15, 20 to evaluate the feasibility of ultrasound in detecting spontaneous pneumomediastinum in the neonatal intensive care unit nicu and illustrate the ultrasound features. Pneumomediastinum is further divided into two groups of spmpatients. According to the results of a study in 1971 by steele rw and coworkers, in which chest films were obtained within two hours after birth in 300 routine vaginal deliveries, 100 premature infants, 100 infants born by cesarean section, and 50 intubated infants, the. A male infant who had been delivered by elective cesarean section to a healthy 41yearold. Pneumomediastinum is air in the center of the chest the mediastinum. A case of isolated left ventricular inflow obstruction caused by a pneumomediastinum in a premature infant is described that resolved with high frequency ventilation. Loculated pneumomediastinum in the newborn radiology. Mediastinal tube placement in a premature infant with. This gradient develops either through overinflation of the alveolus or a reduction. Pneumomediastinum in the newborn infant sciencedirect. C yanosis in the neonatal period presents a difficult problem in differential diagnosis.
Like spontaneous pneumothorax, spm mainly affects adolescent males with a tall, thin body habitus. Apparently, pneumomediastinum is not so rare as one would be led to believe by the sparsity of reports in the literature. Feb 26, 2019 pneumomediastinum pm was first described by laennec in 1819 as a consequence of traumatic injury. A male infant who had been delivered by elective cesarean section to a healthy 41yearold woman at 38 weeks gestation presented at 23 hours of age with increasing respiratory distress. Diagnosis of pneumothorax or pneumomediastinum in the neonate. Spontaneous pneumomediastinum in otherwise healthy. Radiolucency in the superior mediastinum may be caused by a congenital cystic mass or pneumomediastinum. In the ventilated newborn, pneumomediastinum occurs following rupture of overdistended immature or diseased alveoli. Pneumothorax and pneumomediastinum in the newborn rsna.
The most common reported causes of pm in the neonates are exposure to positive pressure ventilation, meconium aspiration syndrome mas, pneumonia or. Spontaneous pneumomediastinum is a rare condition in the newborn, not associated with identifiable trauma or mechanical ventilation. Pneumomediastinum is uncommon in both infants and children 1, 2. The experimental works of macklin and macklin provided insights into its pathophysiology 4, 5. Imaging neonatal spontaneous pneumomediastinum using. Pdf spontaneous multiseptated cystic pneumomediastinum. Great emphasis has been placed on trauma to the head occurring during parturi tion. This gradient develops either through overinflation of the alveolus or a reduction of. Imaging neonatal spontaneous pneumomediastinum using ultrasound. Loculated pneumomediastinum in the newborn loculated pneumomediastinum in the newborn moseley, john e. In infants, the spinnaker sign an upwards and outwards deviation of thymic lobes can be seen when the thymus is raised above the heart by.
Although well at birth, he began to have respiratory distress shortly afterward and required increasing concentrations. Discussion pneumomediastinum, or mediastinal emphysema, is defined as the presence of gas in the mediastinum. Infraazygous pneumomediastinum inthe newborn adelbertbowen11112 frank l. Abstract pneumomediastinum pm occurs in approximately 0. An unexpected finding was a curvilinear lucency outlining the heart, consistent with a pneumopericardium figure 1. Pneumomediastinum in the neonatal and paediatric intensive. Pneumomediastinum is a condition in which air is present in the mediastinum. Diagnosis of pneumothorax or pneumomediastinum in the. It is diagnosed by a combination of physical examination and. Pneumomediastinum is an uncommon cause of neonatal respiratory distress. Pneumomediastinum in newborns this condition is rare in babies, affecting only 0. Pneumomediastinum is the presence of extraluminal gas within the mediastinum.
It contains the heart, thymus gland, and part of the esophagus and trachea. Pneumomediastinum may not be accompanied by any symptoms. Pdf spontaneous neonatal pneumomediastinum researchgate. Pneumomediastinum summary radiology reference article. Anterior mediastinal ultrasound was performed using a linear.
Loculated pneumomediastinum in the newborn, radiology. May 30, 2007 pneumomediastinum pm is defined as a mediastinal air leak. Spontaneous pneumomediastinum spm was reported in 1939 by hamman, for whom the hamman sign see physical is named. A chest xray figures 1 and 2 shows a pneumothorax at the left lung apex and the spinnakersail sign, a sign of pneumomediastinum. Gumbiner and cutler 2 reported several cases and were. It is defined as free air or gas contained within the.
Its radiographic appearance on anteroposterior films of the supine infant may be confused with pneumomediastinum or pneumothorax so that knowledge of the relevant fascial layers is necessary for an understanding of the pathophysiology and allows proper radiographic diagnosis and appropriate treatment. Within 2 h the babys blood pressure mean dropped to the low 30s, the pulse oximetry reading dropped to the high 70s, the heart rate increased to 180 and the babys perfusion was diminished. While mediastinal air accumulation in the ventilated newborn is usually a benign entity, tension pneumomediastinum can embarrass both respiratory and cardiac function. Pneumomediastinum in a newborn infant can produce an alarming andunusual clinical picture characterized by. Spontaneous pneumomediastinum spm is uncommon in children. A baby male was born at 38weeks gestation by an uncom plicated caesarean. A repeat x ray showed a large pneumomediastinum with displacement of the heart to the right. Pneumopericardium is a rare complication of pulmonary disease in the newborn period. Increased subcutaneous fat, characteristic of an infant of a diabetic mother, 2 was noted on chest radiographs, but a glucose tolerance test had not been performed during gestation. First described in 1819 by rene laennec, 1 2 the condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways, or bowel into the.
Neonatal pneumomediastinum is a rare pulmonary air leak syndrome in the neonatal period. The first description of pneumomediastinum in the medical literature was related to a traumatic injury in 1819. Infection is generally not a factor in the newborn but in older children it may be a cause. He had significant lung disease and feed intolerance. Clinical management of the neonatal pneumomediastinum.