What causes elevated alveolar pressure in 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

Numerous maneuvers that lead to elevated alveolar pressures may result in pneumomediastinum (see discussion of the Macklin effect in Pathophysiology).

Forceful coughing, crying, or shouting may elevate pressures. Jones et al [26] report the development of spontaneous pneumomediastinum in a military training recruit after repeatedly shouting "Hooah!" during a motivational squad competition, highlighting that unique to the military training environment, vigorous shouting as a motivational stimulus can have barotraumatic consequences.

Vomiting, defecation, and Valsalva maneuver may elevate pulmonary alveolar pressures, as may illicit drug use, especially if associated with coughing.


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