PNEUMOMEDIASTINUM ASSOCIATED WITH ASTHMA AND PNEUMONIA IN CHILDREN

Abstract

Sixteen instances of pneumomediastinum in children associated with bronchial asthma or bronchopneumonia were analyzed. The asthma group, comprising 9 of the total of 12 patients, was characterized by a history of asthma starting around 2 years of age and an average duration of asthma, before pneumomediastinum occurred, of 7½ years. The mean age of these patients at the time of pneumomediastinum was 9½ years. The patients with pneumonia only were generally younger. The distribution of the mediastinal air was similar to that found after diagnostic pneumomediastinum, being noted most often in the left paracardiac, superior paravertebral, perithymic and precordial areas. Extension of the air to the cervical tissues was common. No pneumothorax was noted. A distinct difference in the manner in which the pressure of the mediastinal air was relieved was noted in the older children when compared to a previously studied group of newborn infants with pneumomediastinum. Decompression in the older children is evidently accomplished through the thoracic inlet tissues; in the newborns there appears to be resistance to this, and consequently the incidence of pneumothorax due to rupture of the mediastinal pleura is quite high. This apparent difference in the course of the disease, evidently due to both the age and the posture of the child, explains the dissimilarity in the roentgen patterns for the same process in the two age groups.