A pneumothorax is caused when air is drawn into the mediastinum, and when it accumulates, it puts pressure on the heart and larger blood vessels, obstructing circulation. Mediastinal pneumothorax is usually mild, although in extreme situations, when it is large, it can be life-threatening.

Mediastinum( spontaneous pneumomediastinum , SPM) can even be life-threatening if it is severe. The presence of air in the mediastinum disturbs the circulatory function, mainly venous. The mediastinum moves to the opposite side. This puts pressure on the large veins in the mediastinum, resulting in a stagnation of circulation in the upper body.

Mediastinal pneumothorax: causes

The most common reasons for the occurrence of mediastinal pneumothorax - the appearance of air in the mediastinum are:

  • rupture of alveoli
  • bronchial or esophageal perforation
  • surgery (dental procedures, surgery on the thyroid gland, tonsils, mediastinoscopy, bone marrow biopsy from the sternum or kidney biopsy)
  • chest injury
  • head and neck injuries
  • injuries within the mediastinum
  • abdominal injuries
  • lung parenchyma injuries
  • mechanical ventilation
  • damage to the lung parenchyma due to barotrauma

Mediastinal pneumothorax can accompany diseases such as:

  • lung abscess
  • tuberculosis
  • emphysema
  • ARDS (acute respiratory distress syndrome)
  • bronchial asthma
  • laryngeal diseases
  • cough

It can also appear after intense vomiting or after straining to pass stools. It can also be caused by a foreign body in the respiratory tract.

Rare causes of mediastinal pneumothorax include:

  • caisson disease
  • convulsions
  • metabolic acidosis in diabetes
  • anorexia nervosa
  • taking psychostimulants and intoxicating substances (e.g. cocaine, marijuana)

Pneumonia: symptoms

Small pneumothorax causes retrosternal pain radiating to the shoulder or directly to the back, a feeling of discomfort in the neck. Large accumulation of air impairs venous circulation. A large emphysema is immediately recognized - it appears:

  • cyanosis of the upper halfbody
  • subcutaneous emphysema
  • cough
  • swallowing disorders
  • shortness of breath
  • tachycardia.

The appearance of an intradermal pneumothorax in the neck area suggests a simultaneous mediastinal pneumothorax.

Mediastinal pneumothorax: diagnosis

In the case of pneumothorax, the Hamman symptom (correct: Laēnnec-Müller-von Bergmann-Hamman symptom), consisting in the presence of crunchy sounds in the mediastinum in the case of pneumonia, which can be heard when the heart contracts and relaxes. This symptom is most easily observed when the patient is lying on his left side.

The diagnosis of pneumothorax is based on indirect symptoms (the causative cause, subcutaneous emphysema of the neck, obstruction of venous circulation in the upper body) and the radiological examination, which shows the presence of air in the mediastinum - x-ray (x-ray of the lungs) is not always reliable, therefore computed tomography is recommended. Bronchoscopy (endoscopic examination of the respiratory tract) and esophagoscopy (esophagus endoscopy) are also performed. The purpose of these tests is to exclude perforation of the trachea, bronchi and esophagus.

Treatment of pneumothorax

Treatment is primarily aimed at eliminating the cause of pneumothorax. Further treatment of mediastinal pneumothorax is usually conservative, because the air from the mediastinum naturally flows into the subcutaneous tissue of the neck. However, if there is increasing obstruction of the venous circulation, surgical drainage (decompression) of the pneumothorax is necessary.

Prognosis in the mediastinum

The prognosis is always serious as it can cause a significant reduction in venous return, central nervous system stagnation and secondary collapse.

Category:

Respiratory system