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Ann Thorac Surg 1995;60:1457
© 1995 The Society of Thoracic Surgeons

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Correspondence

Spontaneous Pneumomediastinum After Sneezing

Radiodiagnostic Thoracic Divisions, Clinique Saint Joseph, Av Baudouin de Constantinople 5, 7000 Mons, Belgium

To the Editor:

We read with interest the case reported by Ralph-Edwards and Pearson on spontaneous pneumomediastinum, which was published in the December 1994 issue of The Annals [1]. Recently, a previously healthy 35-year-old male smoker was referred to us. Immediately after a vigorous sneezing effort, in the setting of a recent upper respiratory viral infection, he presented an acute medial suprasternal pain with gradual onset of dysphagia and odynophagia. Upon examination, an elective pretracheal tenderness with a few subcutaneous crunchings was noted. No other clinical abnormalities were present. The chest roentgenogram confirmed the clinical suspicion of pneumomediastinum. Hospitalization was deemed unnecessary. Clinical and abnormalities disappeared spontaneously after a few days.

The present case invites us to make several comments: First, sneezing, like other activities associated with presumed transient increase of intraalveolar pressure, is a potential cause of pneumomediastinum but is, to the best of our knowledge, not usually reported as such.

Second, we do not agree with Ralph-Edwards and Pearson's [1] comments about the unusual frequency of dysphagia and odynophagia. In 1967, Munsell [2] reported dysphagia with sore throat and neck pain in 72% of the 28 patients in his series. More recently, Yellin and associates [3] and Abolnik and colleagues [4] reported dysphagia in 31% (5/16) and 40% (10/22) of their cases, respectively.

Third, esophageal studies, reported in the article, are not really required unless the clinical conditions for perforation of the aerodigestive tract are present [5].

References

1. Ralph-Edwards AC, Pearson FG. Atypical presentation of spontaneous pneumomediastinum. Ann Thorac Surg 1994;58:1758–60.[Abstract]
2. Munsell WP. Pneumomediastinum. JAMA 1967;202:129–33.[Abstract/Free Full Text]
3. Yellin A, Gapany-Gapanavicious M, Lieberman YA. Spontaneous pneumomediastinum: is it a rare cause of chest pain? Thorax 1983;38:383–5.[Abstract/Free Full Text]
4. Abolnik I, Lossos IS, Breuer R. Spontaneous pneumomediastinum: a report of 25 cases. Chest 1991;100:93–5.[Abstract/Free Full Text]
5. Yellin A. Spontaneous pneumomediastinum. Chest 1992;101:1742–3.

Reply

Cardiovascular Thoracic Surgery Divisions, The Toronto Hospital, General Division, Toronto, Ontario, Canada

To the Editor:

We thank Drs Dechambre, d'Odémont, Cornelis, and Fastrez for their comments regarding our article [1]. As we stated, approximately 70% of patients diagnosed with spontaneous mediastinum can clearly identify a preceding activity associated with the Valsalva maneuver. It is therefore not surprising this entity also may be precipitated by vigorous sneezing.

In the patient series referred to in our article and others, chest or neck pain, mild dyspnea, and dysphagia (difficulty in swallowing) are commonly associated presenting complaints in patients with spontaneous pneumomediastinum. Odynophagia (referring to pain with swallowing) is rarely a stated presentation of spontaneous pneumomediastinum. Constant pain or tightness in the throat independent of swallowing is referred to as pseudodysphagia [2].

The 2 patients we described presented with severe odynophagia in addition to the common signs and symptoms of spontaneous pneumomediastinum. Both were investigated with esophagograms to exclude esophageal pathology and observed overnight in the hospital. It was the dramatic and severe odynophagia these patients presented with that prompted both our investigations and report. As spontaneous pneumomediastinum is a benign process in nearly all affected, if diagnosis can be made with certainty, no further investigation or treatment is necessary.

References

1. Ralph-Edwards AC, Pearson FG. Atypical presentation of spontaneous pneumomediastinum. Ann Thorac Surg 1994;58:1758–60.[Abstract]
2. Edwards DAW. Gastroenterological problems. The problem of dysphagia. Practitioner 1978;216:631–6.

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This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): F. Griffith Pearson Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dechambre, S. Articles by Pearson, F. G. Search for Related Content PubMed PubMed Citation Articles by Dechambre, S. Articles by Pearson, F. G.