Causes of spontaneous pneumomediastinum in children

Respiratory conditions and maneuvers:

Asthma

Cystic fibrosis

Upper and lower respiratory tract infections (laryngitis, bronchiolitis obliterans, measles, pertussis, Mycoplasma pneumonia and influenza)

Valsalva maneuver (eg, lifting heavy objects, blowing balloons, labor, coughing, crying, screaming, strenuous exercise)

Foreign body aspiration

Inhalation of helium

Inhalation of illicit drugs

SCUBA diving

Pulmonary function testing

Irritant gases

Gastrointestinal conditions:

Vomiting (due to gastroenteritis, gastroesophageal reflux disease, and other causes, with increased risk in the setting of malnutrition)

Spontaneous rupture of esophagus (Boerhaave syndrome)

Gastric perforation

Rupture of rectum

Other factors:

Strenuous exercise

Seizure

Hyperpnea (eg, in the setting of ketoacidosis)

Centrifuge training

Rheumatologic diseases

References:

Chalumeau M, Le Clainche L, Sayeg N, et al. Spontaneous pneumomediastinum in children. Pediatr Pulmonol 2001; 31:67.
Vázquez JL, Vázquez I, González ML, et al. Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia. Pediatr Radiol 2007; 37:1286.
Yoshida K, Kurosaka D, Kingetsu I, et al. Pneumomediastinum in dermatomyositis itself is not a poor prognostic factor: report of a case and review of the literature. Rheumatol Int 2008; 28:913.
Muñiz AE. False-negative capnographic reading caused by a malfunctioning bag-valve-mask device resulting in a pneumomediastinum. Resuscitation 2008; 78:378.
Le Loch JB, Freymond N, Khettab F, et al. [Pneumomediastinum, giant subcutaneous emphysema and pneumoperitoneum revealed by jaw pain. Uncommon physiopathology of pneumomediastinum]. Rev Pneumol Clin 2008; 64:30.
Huang HR, Wong KS, Lien R, Chiu CY. Spontaneous pneumomediastinum due to gastroesophageal reflux disease in an adolescent boy. Respirology 2008; 13:744.
Hahn CD, Choi YU, Lee D, Frizzi JD. Pneumoperitoneum due to gastric perforation after cardiopulmonary resuscitation: case report. Am J Crit Care 2008; 17:388.

Graphic 61465 Version 6.0