Paul L Tahalele, Merlinda Dwintasari, Y Motulo, Yan Efrata Sembiring, Dhihintia Jiwangga Suta


Mediastinum is defined as the area demarcated by the thoracic inlet superiorly, the diphragm inferiorly, and the pleural cavities laterally. The mediastinum is a division of the thoracic cavity that contains thymus gland, the heart, trachea and portions of the seophagus, and other structures. Mediastinum divided into 3 region, anterior, posterior, superior, and middle regions.
Pneumomediastinum or emphysematous mediastinum is existence of free air in the mediastinum due to spontaneous or secondary reasons. That can be confirmed with thorax X-Ray or CT- Scan thorax. The symptomps are severe central chest pain, shortness of breath, subcutaneous emphysema, laboured breathing and voice distortion. In physical diagnosis, especially on auscultation, there is spesific sign called “Hamman’s Crunch” (crunching sound corresponding with the cardiac cycle (Hamman’s Crunch).
Pneumomediastinum can leadto pneumopericardium, pneumotoraks, penumoretroperitonium or penumoperitonium. Air in the mediastinal cavity can be absorbed by itself slowly, so penumomediastinum can treated non-operatively.

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Mediastinum, Pneumomediastinum, Treated Conservatively

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Agut A, Talavera J, Buendia A, et al. Imaging diagnosis spontaneous pneumomediastinum secondary to primary pulmonary pathology in a dalmatian dog. Vet Radiol Ultrasound 2014. [Epub ahead of print].

Al-Mufarrej F, Gharagozloo F, Tempesta B, et al. Spontaneous cervicothoracolumbar pneumorrhachis, pneumomediastinum and pneumoperitoneum. Clin Respir J 2009;3:239-43.

Bejvan SM, Godwin JD. Pneumomediastinum: Old Sign and New Sign. American Journal of Roentgenology. 1996;166:1041-1048.

Caceres M, Ali SZ, Braud R, et al. Spontaneous pneumomediastinum: a comparative study and review of the literature. Ann Thorac Surg 2008;86:962-6.

Cakmak M, Yuksel M, Kandemir MN. Analysis of Patients With Spontaneous Pneumomediastinum. Turk Thorac J. 2016;17:105-108.

Carolan PL, Pneumomediastinum. Medscape. 2019. 4-11.

Chu CM, Leung YY, Hui JY, et al. Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome. Eur Respir J 2004;23:802-4.

Hamman L. Spontaneous mediastinal emphysema. Bull Johns Hopkins Hosp 1939;64:1-21.

Hammond DI. The "ring-around-the-artery" sign in pneumomediastinum. J Can Assoc Radiol 1984;35:88-9.

Iyer VN, Joshi AY, Ryu JH. Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients. Mayo Clin Proc 2009;84:417-21.

Koaritas VK, Papagiannopoulos K, Lazaridis G, et al. Pneumomediastinum. Journal of Thoracic Disease. 2015; 7(S1): S44-S49.

Kobashi Y, Okimoto N, Matsushima T, et al. Comparative study of mediastinal emphysema as determined by etiology. Intern Med 2002;41:277-82.

Langwieler TE, Steffani KD, Bogoevski DP. Spontaneous Pneumomediastinum. Ann Thorac Surg. 2004;78:71-3.

Lee YJ, Jin SW, Jang SH, et al. A Case of Spontaneous Pneumomediastinum & Pneumopericardium in A Young Adult. The Korea Journal of Internal Medicine. 2001; 16:4-6

Macia I, Moya J, Ramos R, et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg 2007;31:1110-4.

Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions: an interpretation of the clinical literature in the light of laboratory experiment. Medicine 1944;23:281-358.

Meireles J, Neves S, Castro A, et al. Spontaneous Pneumomediastinum Revisited. Respiratory Medicine CME. 2011;5:181-183

Pooyan P, Puruckherr M, Summers JA, et al. Pneumomediastinum, pneumopericardium, and epidural pneumatosis in DKA. J Diabetes Complications 2004;18:242-7.

Russo A, Del Vecchio C, Zaottini A, et al. Role of emergency thoracic ultrasonography in spontaneous pneumomediastinum. Two case report. G Chir 2012;33:285-96.

Sahni S, Verma S, Grullon J, et al. Spontaneous Pneumomediastinum: Time For Concensus. North American Journal of Medical Sciences. 2013;5:460-463