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Pneumomediastinum
Air or gas in the mediastinum is called pneumomediastinum.
Etiology
Pneumomediastinum is typically caused by alveolar rupture which can be due to either a spontaneous or traumatic cause. A spontaneous pneumomediastinum can either be primary without an underlying etiology or can occur secondary to an underlying cause. Primary pneumomediastinum can be due to increases in intrathoracic pressure as is seen with a Valsalva maneuver, vomiting, Boerhaave syndrome (esophageal perforation), weightlifting, and choking events. Common causes of secondary pneumomediastinum in children younger than age 7 years are lower respiratory tract infections and asthma exacerbations. Simultaneous pneumothorax is unusual in these patients. Other causes of secondary pneumomediastinum are anorexia nervosa, normal menses, and diabetes mellitus with ketoacidosis. Traumatic causes of pneumomediastinum include both iatrogenic (dental extractions, adenotonsillectomy, high flow nasal cannula therapy, esophageal perforation, and inhalation of helium gas), and non-iatrogenic (inhaled foreign body, penetrating chest trauma, and illicit drug use).
Pathogenesis
According to the Macklin effect , after an intrapulmonary alveolar rupture, air dissects along the pressure gradient through the perivascular sheaths and other soft tissue planes toward the hilum and enters the mediastinum.
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