Pneumomediastinum

Pneumomediastinum (synonym mediastinal emphysema) - accumulation of air in tissues of mediastinum. Pneumomediastinum may occur because of chest injuries (fractures of ribs), if the injuries with infringement of an integrity of the trachea, bronchus, lung and esophagus, resulting in surgical interventions on the lungs (lack of seams stump bronchus), as well as in the destruction of the wall of the esophagus or trachea disintegrating malignant tumor. Sometimes pneumomediastinum comes as a result of damage to the esophagus from rough instrumental examination of his (ezofagoskopia), birovni.
Nastavenie of air in each breath leads to a rapid increase pneumomediastinum, the distribution of air in the subcutaneous tissue of the neck, face, chest and even the whole body. The General condition of patients in these cases, deteriorating, appear difficulty breathing, shortness of breath, cyanosis, lowering blood pressure, heart disorder. X-ray examination revealed the air in the mediastinum; in the zone of distribution of emphysema (see) with the feeling is determined air crepitus (see).
Patient with traumatic pneumomediastinum subject to immediate hospitalization. Evacuation - on a stretcher, in a half-sitting position. In severe cases shown oxygen inhalation, the introduction of heart and narcotic drugs. Hospital - anesthesia area of broken ribs, neck car-sympathetic blockade on Vishnevskaya, with increase of symptoms pneumomediastinum - opening of fiber mediastinum (mediastinotomy). If pneumomediastinum supported tense pneumothorax (see), it is necessary to establish an underwater drainage of the pleural cavity.
Artificial pneumomediastinum (gas introduction in the mediastinum) apply to the x-ray diagnostics of tumors and tumor formations mediastinum.

Pneumomediastinum (pneumomediastinum; from the Greek. pneuma - air and Postnet. mediastinum - mediastinum; synonym mediastinal emphysema) - accumulation of gas in mediastinal tissue.
There are pneumomediastinum traumatic and spontaneous. Traumatic P. develops after damage the lungs, trachea, esophagus, after operations on the lungs (often due to the divergence of seams on the cult of bronchus). The destruction of these bodies a growth or inflammation (gap tuberculosis caverns) may also be accompanied by P. Spontaneous P. rarely occurs in children with whooping cough, pneumonia, croup. Gas can penetrate into the mediastinum of retroperitoneal fat (for example, when you break duodenal ulcer) or subcutaneous tissue of the neck (at fracture of ribs with lung damage and subcutaneous emphysema chest and neck).
Acute P. causes a feeling of pressure in the chest, shortness of breath, cyanosis. With the gradual same development even significant P. does not cause significant illness and air, accumulated in the tissue of the mediastinum in the amount of 2,000-2,500 ml, gradually absorbed.
Symptoms pneumomediastinum is the weakening of cardiac impulse, the disappearance of the dullness of heart, air crepitus on the neck in the chest, on the chest wall; especially characteristic x-ray picture. Treatment is required only for severe growing P. It consists in the opening and drainage fiber anterior mediastinum through an incision in the jugular fossa or in operation in respect of a busy pneumothorax, if any. In the most severe cases shows of thoraco - or mediastinotomy with revision of the mediastinum.
Artificial P. apply for pneumomediastinum (see). The air entering the mediastinum by pneumomediastinum, does not cause pain, absorbed slowly (7 - 10 days). Oxygen worse tolerated, as it causes pain in the sternum; resolved quickly (1-2 days). Nitrous oxide disappears from the mediastinum even faster - within a few hours.