Management of spontaneous pneumomediastinum in children

Abstract Purpose We characterize the outcomes of pediatric spontaneous pneumomediastinum in the largest series to date and propose a management pathway. Methods All patients at our institution with ICD-9 code 518.1 confirmed to have isolated radiographic findings of spontaneous pneumomediastinum between January 2003 and February 2014 were retrospectively reviewed for admission, intensive care unit (ICU) stay, complications, and outcome. Results We identified 96 children with 99 episodes, median age 14.1years (IQR: 8.7–16.4). Primary symptoms were chest pain, cough, and dyspnea. Most were hospitalized (n=91, 91.9%), with 20 (20.2%) admitted to ICU. Median lengths of stay (LOS) were 1day (IQR: 1–2) for non-ICU admissions and 3days (IQR: 2–3) for ICU admissions. The surgical service discharged non-ICU patients 0.94days earlier than medical services (95% CI 0.38–1.50, p =0.0014). Asthma affected neither LOS nor ICU admission rates. Follow-up imaging, when obtained (n=81, 81.8%), did not alter management. Recurrences occurred in three asthmatics, all after one year. Each was rehospitalized and discharged uneventfully. No patient developed pneumomediastinum-related complications (e.g., pneumothorax, pneumopericardium, or mediastinitis). Conclusion Spontaneous pneumomediastinum without associated comorbidities can be managed with expectant outpatient observation without further imaging. Children with asthma should be treated independent of spontaneous pneumomediastinum.