What is the role of the dissection of free air in the pathophysiology of pneumomediastinum (PM)?

Updated: Feb 26, 2019
  • Author: Patrick L Carolan, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Answer

The dissection of free air may not be confined solely to the mediastinum. Zylak et al note that the mediastinum communicates with the submandibular space, the retropharyngeal space, and vascular sheaths within the neck. [3] In addition, 2 routes of communication with the retroperitoneum have been noted: via a tissue plane extending through the sternocostal attachment to the diaphragm, as well as periaortic and periesophageal fascial planes. As a result, air present within the mediastinum may dissect through these tissue planes, causing pneumopericardium, pneumothorax, subcutaneous emphysema, pneumoperitoneum, or pneumoretroperitoneum.

Carolan et al report a case of spontaneous pneumomediastinum associated with the presence of air within the cervical and thoracic spinal canal indicative of air dissection from the mediastinum, neck, and back through soft-tissue planes and the neural foramina into the spinal canal. [4] They suggest use of the term “spontaneous pneumorrhachis” for patients with this finding.


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