UMEM Educational Pearls

Category: Pediatrics

Title: Spontaneous Pneumomediastinum in Children: What should I do?

Keywords: Spontaneous Pneumomediastinum, asthma, crepitus, esophagram (PubMed Search)

Posted: 9/15/2023 by Jennifer Guyther, MD
Click here to contact Jennifer Guyther, MD

Spontaneous pneumomediastinum (SPM) is air within the mediastinum in the absence of trauma.  This occurs more often in males and has 2 age peaks: children younger than 6 years as a result of lower respiratory tract infections and adolescents due to asthma exacerbations.  Typical symptoms include chest pain, subcutaneous emphysema and shortness of breath, but can also include neck pain, dysphagia, pneumopericardium, and pneumorrhachis (air in the spinal cord).   SPM has been seen in patients with a history of asthma, current influenza infection and hyperventilation with anxiety, but many have no known precipitating factor. 
The diagnosis of SPM is typically made on CXR.  The literature is mixed on the utility of CT scans, esophagrams, esophagoscopy and bronchoscopy.  This study looked at 179 pediatric patients who were diagnosed with SPM.  No patients were found to have an esophageal injury.  Also, CT scans did not provide additional information or change management based on what was seen on the chest xray.
The author's concluded that CT scans and esophagrams can be avoided unless there is a specific esophageal concern.  Management should be guided based on the patient's symptoms.


Roby K, Barkach C, Studzinski D, Novotny N, Akay B, Brahmamdam P. Spontaneous Pneumomediastinum is Not Associated With Esophageal Perforation: Results From a Retrospective, Case-Control Study in a Pediatric Population [published online ahead of print, 2023 Apr 23]. Clin Pediatr (Phila). 2023;99228231166997. doi:10.1177/00099228231166997