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Spontaneous Pneumomediastinum
- Spontaneous pneumomediastinum is largely a benign disease typically seen in young males ages 18-21 years
- It is typically caused by activities that increase alveolar pressure such as coughing, sneezing, vomiting, inhalational drug use, and Valsalva maneuver
- The most common symptoms include chest pain and dyspnea; chest pain is usually centrally located, may radiate to the neck, and may be worse with inspiration
- CT scan is the "gold standard"; CXR is a good place to start but it is normal in up to 30% of cases
- The vast majority of patients do not require admission or supplemental O2
- Advise patients to avoid strenuous activity until after symptom resolution (typically takes about 2 weeks)
- Any patient with a fever, elevated WBC count, hemodynamic instability, severe dysphagia or odynophagia should first be evaluated for infectious mediastinitis or esophageal perforation (spont. pneumomediastinum is a diagnosis of exclusion in these patients)