Tension pneumomediastinum
G. Van Stiegmann, C. O. Brantigan and A. R. Hopeman
Tension pneumomediastinum is an infrequently diagnosed but potentially
fatal condition. The collection of air under pressure in the mediastinum
compromises venous return to the heart and compresses major bronchi,
leading to sudden and profound cardiovascular collapse. Although its
mechanism was elucidated in the 1940's, when tension pneumomediastinum was
most commonly a complication of tuberculosis, the same mechanism explains
its formation in neonates with respiratory distress and in patients
ventilated with volume respirators. Awareness of this condition will lead
to more frequent diagnosis, but, more important, will also lead to prompt
mediastinotomy and relief of this rapidly fatal condition.
