Pneumomediastinum

Also called: Mediastinal Emphysema

Overview

What Is Pneumomediastinum?

In the middle of the chest is a cavity called the mediastinum (me-dee-uh-STY-num), which holds the heart and major blood vessels. If air leaks out of the lungs or from other parts of the respiratory system and gets trapped in this space, it’s called pneumomediastinum (new-mo-me-dee-uh-STY-num). The condition is rare in kids and teens.

Pneumomediastinum can happen after doing something that strains breathing, like forceful coughing, or having an illness or surgery.

Most cases are mild and get better on their own.

Top Things to Know

Pneumomediastinum happens when air gets trapped in the center of the chest.
Symptoms can include chest pain, shortness of breath, and trouble swallowing.
Kids often get better with rest and soon after return to normal activities.
It can happen after things like strong coughing, vomiting, or an asthma flare-up.

Signs & Symptoms

What Are the Symptoms?

Sometimes kids don’t have any symptoms of pneumomediastinum, but when they do happen, they may include:

chest pain that may spread to the arms or neck
trouble breathing or shortness of breath (not being able to breathe in enough air)
strong coughing or fast, shallow breathing
a crackling feeling under the skin of the neck or chest (called subcutaneous emphysema) due to air bubbles or pockets of air
neck pain or swelling
painful swallowing or trouble swallowing
hoarse voice

Rarely, pneumomediastinum can cause more serious problems, like pneumothorax (a collapsed lung) or too much pressure on the heart.

When Should I Call the Doctor?

Call your doctor if your child has symptoms of pneumomediastinum, and especially for:

chest pain that doesn’t get better or worsens
a fever of 100.8°F (38.2°C) or higher
trouble breathing
vomiting that doesn’t go away

Causes

What Causes Pneumomediastinum?

Pneumomediastinum happens when lung tissue gets tiny tears in it and air leaks through. The air seeps into the middle of the chest.

There are different kinds of pneumomediastinum based on the cause.

Spontaneous Pneumomediastinum

Spontaneous pneumomediastinum is when a healthy person gets pneumomediastinum and the cause isn’t clear. It happens more in teens and could be due to things like:

hard coughing or sneezing
vomiting that’s strong or that keeps happening
picking up a heavy item
holding breath

This kind of condition is more common in people who smoke, vape, or use drugs.

Secondary Pneumomediastinum

Secondary pneumomediastinum is usually related to a health condition, an injury, or surgery. It could be due to things like:

asthma that isn’t managed well, cystic fibrosis, pneumonia, or COVID-19
a chest injury
surgery in the chest, esophagus (the tube that connects the mouth to the stomach), or neck
mechanical ventilators (machines that do the breathing for people when the lungs can’t)
infection
inhaled marijuana
scuba diving

Premature babies are more likely to have secondary pneumomediastinum because their lungs aren’t fully developed and they may have breathing problems.

Diagnosis

How Is It Diagnosed?

Doctors do a physical exam and ask about symptoms of pneumomediastinum. Kids may have a chest X-ray or chest CT (CAT) scan, which can show if there’s air in the mediastinum. They may need other tests as well, depending on what the doctor thinks might be the cause.

Treatment & Care

Pneumomediastinum usually goes away in a few days and kids can get back to their normal activities soon.

How Is Pneumomediastinum Treated?

Most kids don’t need treatment for pneumomediastinum because the body slowly absorbs the air trapped in the center of the chest. Taking medicines for pain (like acetaminophen and ibuprofen) or vomiting can ease symptoms and help kids feel more comfortable as they rest.

If a child has a condition, like asthma, medicine or other treatment might be needed for it. Doctors can also go over how to better manage asthma to help prevent pneumomediastinum from happening again.

Some kids, mainly babies, may need to spend a few days in the hospital. They might get extra oxygen to help the body absorb the trapped air faster.

What Should My Child Avoid While Recovering?

As kids recover from pneumomediastinum, they need to be careful not to reinjure the chest area. Encourage them to:

avoid too much crying, coughing, and yelling
skip heavy exercise and activities that strain breathing, like:
- playing wind musical instruments (ones you blow in, like a flute)
- lifting weights
- scuba diving
not smoke or inhale drugs