Spontaneous pneumomediastinum is largely a benign disease typically seen in young males ages 18-21 years
It is typically caused by activities that increase alveolar pressure such as coughing, sneezing, vomiting, inhalational drug use, and Valsalva maneuver
The most common symptoms include chest pain and dyspnea; chest pain is usually centrally located, may radiate to the neck, and may be worse with inspiration
CT scan is the "gold standard"; CXR is a good place to start but it is normal in up to 30% of cases
The vast majority of patients do not require admission or supplemental O2
Advise patients to avoid strenuous activity until after symptom resolution (typically takes about 2 weeks)
Any patient with a fever, elevated WBC count, hemodynamic instability, severe dysphagia or odynophagia should first be evaluated for infectious mediastinitis or esophageal perforation (spont. pneumomediastinum is a diagnosis of exclusion in these patients)
