Does your chest feel tight? Let's learn about pneumomediastinum!

Have you ever had a sudden pain in the middle of your chest and difficulty breathing? Or have you suddenly experienced swelling in your neck or face? Perhaps the condition we are talking about today is called pneumomediastinum. Don't worry, let's talk about this simply.

What exactly is pneumomediastinum?

Simply put, pneumomediastinum is the accumulation of air in the space between your lungs, where your heart is located. In medicine, we call this space the mediastinum. It's like a balloon filling up with air, and it happens when air leaks into this space called the mediastinum.

Most of the time, this happens after an accident, illness, or surgery. In itself, this condition, called pneumomediastinum, may seem harmless. However, the underlying cause can sometimes be serious. That's why it's important to be aware of it. Some people also call it "mediastinal emphysema."

Are there types of this?

Yes, there are mainly two types:

1. Spontaneous Pneumomediastinum (SPM): In this, air accumulates without any obvious cause, injury, or illness. Sometimes the cause may not even be found.

2. Secondary Pneumomediastinum: This is caused by something like an accident, illness, or surgery.

How common is pneumomediastinum?

This is actually not a very common condition. According to experts, spontaneous pneumomediastinum (SPM) affects about one in 25,000 people between the ages of 5 and 34. This is the age group that is most likely to develop SPM.

Is this an emergency? Should I be worried?

Here is something that needs to be understood well.

• If you have spontaneous pneumomediastinum (SPM) , meaning it occurs without an obvious cause, it is usually not an emergency.
• However, if your mediastinum is filled with air due to an accident or illness (secondary type), it needs to be treated quickly.

Most importantly: If you have chest pain and difficulty breathing, it could be a sign of a serious, life-threatening condition. Therefore, if you experience such symptoms, go to the nearest hospital emergency department immediately.

What is the difference between pneumomediastinum and pneumothorax?

These two can be a bit confusing.

• Pneumothorax is a collapsed lung. This happens when air builds up between the lung and the chest wall. The pressure of that air causes the lung to collapse.
• Pneumomediastinum is the accumulation of air in the space between the lungs (the mediastinum).

Simply put, in a pneumothorax, air is around the lung, and in a pneumomediastinum, air is between the two lungs. Got it?

What are the symptoms of this? See if you have these too

Not everyone may experience symptoms, but the most common symptoms are:

• A sharp pain in the middle of the chest or near the breastbone. This pain may spread to the arms or neck. This pain may also increase when breathing or swallowing. Imagine it, as if someone is squeezing your chest.
• Shortness of breath.
• Subcutaneous emphysema is a condition where air bubbles feel like they are under the skin of the face, neck, or chest. It may feel like there are small balls under the skin, and may make a "squeaky" sound when pressed with a finger.
• Swelling of the neck or face.
• Voice changes, for example, the voice becomes high-pitched.

Some people can have pneumomediastinum without any of these symptoms.

Why is this happening? What are the reasons?

Pneumomediastinum is most often caused by damage to an organ or structure inside your body, causing air to leak into the mediastinum. Examples of this include:

• Your windpipe (trachea) or bronchi (bronchi)
• Alveoli (small air sacs in the lungs)
• The tube that goes from the throat to the stomach, that is, the esophagus (`Esophagus`)
• Intestines

Air leaks into the mediastinum from a place like this.

Spontaneous pneumomediastinum (SPM) can also be caused by anything that suddenly increases the pressure inside your chest (although this is somewhat rare). Sometimes, doctors can't find a cause at all.

Some specific reasons could be:

• Serious trauma to the chest , such as a car accident.
• Surgery.
• The small air sacs (alveoli) in the lungs burst.
• A perforation or tear in the airway or digestive tract (Gastrointestinal tract or GI tract).
• Bacterial, fungal, or viral infections.
• Things that suddenly increase chest pressure, such as coughing, sneezing, or vomiting . Imagine, some people can even experience this condition when they cough loudly.
• Straining when going to the toilet.
• Pushing during childbirth.
• Inhaling drugs such as cocaine or marijuana.
• Scuba diving.
• Mechanical ventilation.

Who is at higher risk of developing this condition?

You may be at higher risk of developing this condition if you:

• If you are a smoker.
• If you have lung diseases such as asthma or COPD (Chronic Obstructive Pulmonary Disease).
• If you are a user of inhaled recreational drugs.
• If you have recently undergone abdominal, neck, or chest surgery.
• If you have recently given birth to a child.

Can pneumomediastinum cause complications?

Complications from this condition are very rare, but they can be life-threatening and require prompt treatment. Such complications include:

• The accumulated air can cause pressure around the lungs and cause one lung to collapse (pneumothorax).
• Air can move from the mediastinum into the space between the pericardium and the heart. This is called pneumopericardium .
• If too much air accumulates, it can put pressure on structures inside the chest, such as the heart and large blood vessels. If this happens, they may not function properly.

How does a doctor diagnose this? (Diagnosis)

A doctor usually diagnoses pneumomediastinum with a chest X-ray or a CT scan (Computed Tomography scan), which takes pictures of the inside of the chest.

When the doctor listens to your heart and lungs with a stethoscope, if he hears a "crunching" sound in the rhythm of your heart beating, that is also a sign that there is air in the mediastinum (Hamman's sign). Then, tests like X-rays and CT scans are ordered.

What are the treatments for this?

The good news is that most cases of pneumomediastinum do not require any specific treatment. Unless it is severe, your body will gradually clear the air on its own. Oxygen therapy can help speed up the process.

However, if you have another underlying health condition (e.g., an infection, damage to an internal organ), your doctor will treat that condition.

Treatment if hospitalized:

Sometimes your doctor may keep you in the hospital for observation or treatment for 24 days or more. During this time, you may receive treatments such as:

• Oxygen therapy: Breathing in extra oxygen helps the body absorb air more quickly.
• Medication: Medications such as painkillers and cough suppressants are given to control symptoms until the body absorbs the extra air.
• Needle aspiration: This is a very rare procedure. Only if the air has accumulated to the point where it is putting severe pressure on the structures inside the body, will a doctor insert a needle to remove some of the air, or will they insert a small tube (drain).

Can pneumomediastinum be fatal?

Pneumomediastinum itself is not fatal. However, it can sometimes be caused by other serious, life-threatening health conditions. Your doctor will find the cause of the air buildup and treat it if necessary.

Are there ways to prevent this from happening?

Because this is a rare condition and researchers still don't fully understand all the causes and risk factors, there are no specific ways to prevent it. Not smoking and not using inhalants may help reduce your risk.

How long will it take to heal?

• People with spontaneous pneumomediastinum (SPM) usually stay in the hospital for about three days, but sometimes they have to stay for a week or more.
• People who develop pneumomediastinum due to an underlying cause (secondary type) may need to stay in the hospital for up to several weeks, depending on the severity of the underlying condition.

Can this be cured completely?

• Spontaneous pneumomediastinum (SPM) usually resolves on its own without any treatment. Unless there is an underlying health condition, the risk of recurrence is low.
• The underlying health conditions that caused this can sometimes be treated.

So, what does the future hold? (Outlook)

Your future depends on what caused the air to collect in your mediastinum.

• People with spontaneous pneumomediastinum (SPM) recover completely, and recurrence is very rare.
• If you have secondary pneumomediastinum , your recovery will depend on the severity of your underlying condition. Sometimes, the underlying conditions that cause pneumomediastinum can be fatal.

When should you seek medical advice?

If you experience chest discomfort, facial swelling, or a sudden change in your voice, especially if you have recently had surgery or given birth, be sure to see a doctor.

When should you go to the Emergency Treatment Unit (ETU) ?

If you have these symptoms , seek medical advice immediately, or go to the nearest hospital emergency room:

• Chest pain.
• Difficulty breathing.
• Severe swelling of the face or neck.
• Lightheadedness /fainting.

Important questions to ask your doctor

When you see the doctor, it will be helpful for you to ask these questions:

• What is causing this situation for me?
• How serious is my condition?
• How to treat the cause?
• What treatment options do I have?
• How long will it take for me to recover?
• What can I do to prevent this from happening again?

Take-Home Message

Spontaneous pneumomediastinum (SPM) is usually not serious, but you may need to stay in the hospital for a few days. However, secondary pneumomediastinum, which occurs after an illness or accident, requires immediate treatment of the underlying cause. Your doctor will tell you more about your specific condition. The most important thing is to stay calm, pay attention to your symptoms, and seek medical advice if necessary.

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