The so-called mediastinal emphysema describes the accumulation of air in the mediastinum. The disease usually occurs in connection with mechanical ventilation. The main cause is an alveolar overpressure, which can occur, for example, as a result of a Valsalva maneuver, a coughing disorder or blunt chest trauma.
What is mediastinal emphysema?
The mediastinum is a space located between the two lungs. Several vital organs such as the heart and respiratory tract lie here. This surrounds a supporting tissue, the so-called connective tissue. This ensures that the corresponding organs find a stable hold in the mediastinum. See AbbreviationFinder for abbreviations related to Mediastinal Emphysema.
Mediastinal emphysema occurs due to the passage of air into the mediastinal area. This usually escapes from the so-called alveolar space. Lung function is rarely affected. In most cases, the disease occurs in conjunction with a pneumothorax or skin emphysema. Own symptoms rarely occur.
The attending physician can perceive a crackling sound by palpating the jugulum. If there is pronounced mediastinal emphysema, those affected often suffer from severe pericardial symptoms. In addition, in the case of pronounced mediastinal emphysema, so-called inflow congestion occurs.
In principle, air escapes with all perforations of air-filled organs. The bronchial area or the gastrointestinal tract are usually affected, from which air can enter the mediastitunum. The doctor distinguishes between spontaneous and non-spontaneous mediastinal emphysema.
The so-called spontaneous mediastinal emphysema occurs without prior trauma. Lung diseases are usually not the underlying cause. Spontaneous mediastinal emphysema often follows an intrathoracic increase in pressure. It is believed that air leaks from the airways into the mediastinum as a result of rupture of the alveoli.
In most cases, pressure-increasing factors such as severe coughing, vomiting, stress or asthma can be identified. In addition, it is likely that the body’s inflammatory reactions in what is known as bronchial asthma cause rupture of the peripheral alveoli.
Other possible causes are spontaneous pneumomediastinum, narrowing of the airways, the Valsalva maneuver, drug abuse or invasive ventilation.
There are many causes of non-spontaneous pneumothorax. Leaking air as a result of trauma to a hollow organ or a tumor is life-threatening. Mediastinal emphysema can also be caused by foreign bodies that have penetrated the lungs.
Symptoms, Ailments & Signs
The organs located in the chest are displaced by the air. The individual complaints depend mainly on which organs were affected by this process. Patients usually suffer from severe pain in the heart or chest area. If the trachea narrows, breathing problems occur.
If the esophagus is affected, patients complain of difficulty swallowing. If blood vessels or the heart are involved, the symptoms cannot always be clearly assigned. In this case, tachycardia and shortness of breath often occur, which also suggests other diseases. It is also possible that the escaping air penetrates into the skin. A characteristic of this so-called skin emphysema is the visible accumulation of air in the neck area and on the arms.
Diagnosis & disease progression
The air that collects in the mediastinal space can often be perceived by the doctor as a crackling sound. This is caused by the air bubbles that are under the skin. Chest x-ray shows a widened mediastinal space. An inconspicuous mediastinum usually shows up as a narrow white area between the two lungs, which appear dark in the image.
Air that has entered the mediastinal space makes this area appear wider. On the x-ray, this air-filled area can be seen as a dark section, just like the lungs. All organs that contain fluid show a bright area on X-rays. This can also be recognized by the blood-filled heart, which forms the white area in the mediastinum.
Mediastinal emphysema can cause various symptoms. As a rule, the symptoms depend heavily on which organs are displaced in which direction and may be deformed and damaged in the process. For this reason, a general course of the disease cannot be predicted. In most cases, however, there is discomfort and pain in the heart.
It is not uncommon for those affected to suffer from feelings of anxiety or panic attacks. Pain occurs, which can also spread to other regions of the body. Not infrequently, mediastinal emphysema is also associated with breathing difficulties. Furthermore, swallowing difficulties also occur, so that the intake of food and liquid is usually no longer possible without further ado.
Shortness of breath can also cause people to lose consciousness and potentially injure themselves if they fall. If mediastinal emphysema is not treated, the patient may die. In most cases, no direct treatment is necessary for mediastinal emphysema. Surgical intervention is only carried out in acute emergencies, but this is not associated with any complications. With successful treatment, the patient’s life expectancy will not be reduced by mediastinal emphysema.
When should you go to the doctor?
People who are mechanically ventilated are increasingly in the risk group for mediastinal emphysema. Therefore, in particular those affected who are in the appropriate state of health should inform the doctor treating them if there are any changes or abnormalities. Restricted breathing, unusual breathing sounds or severe pain in the chest are signs of possible disorders and existing problems. A doctor should be informed immediately so that treatment can be optimized. Difficulty swallowing, tachycardia, sweating and anxiety are signs of existing irregularities. If there is an increase in existing symptoms or if symptoms spread further, you should see a doctor as soon as possible.
If there is a visible accumulation of air in the arms and neck of the affected person, a doctor is needed. If a lack of oxygen in the organism is noticed, the skin becomes pale or the skin turns blue, a doctor should be consulted. A decrease in physical resilience, fatigue, rapid fatigue and sleep disorders are indications that must be examined and treated. If, in addition to the physical stress, there are also mental stress conditions, a doctor should also be consulted. Medical support can be helpful in the case of depressive behavior, aggressive tendencies or severe mood swings. Withdrawal from social life, tearfulness, or apathy indicate mental health issues that should be addressed and resolved.
Treatment & Therapy
Mediastinal emphysema is usually only treated symptomatically. In most cases, without treatment, the air will disappear on its own as it is absorbed by the surrounding tissue. In technical terms, this process is referred to as resorption. The pressure in the mediastinal area is rarely so high that the air has to be evacuated.
When this becomes necessary, an invasive procedure is required, in which an incision is made in the patient’s neck. This allows the air to escape. If mediastinal emphysema develops into a life-threatening condition, this operation is performed. In principle, only the underlying diseases are treated. These include, for example, closing a rupture or using ventilators.
If the patients are free of symptoms and complaints, no further therapy is required. If the pain is severe, an incision is indicated cranially to the sternum, where a cannula is inserted into the mediastinum. This will allow the air to escape.
Outlook & Forecast
The prognosis of mediastinal emphysema depends on the classification of the disease. A distinction is made between spontaneous and non-spontaneous mediastinal emphysema. The prognosis for spontaneous emphysema is favorable. Nevertheless, medical treatment should take place so that there are no complications. Symptomatic treatment takes place until freedom from symptoms can be documented. Spontaneous healing can be observed in a large number of patients. The air finds its way out of the organism independently and without further measures.
Surgery is only necessary in severe cases. This is associated with risks and can lead to consequential problems. Nevertheless, it is usually a routine process that is usually carried out without any problems.
In the case of non-spontaneous mediastinal emphysema, the prognosis is usually unfavorable due to the overall situation. There are previous illnesses that lead to severe health impairments. The patient’s condition is classified as life-threatening. In the event of an unfavorable course, the affected person dies prematurely.
If the acute condition is successfully overcome, further therapy is required. Control examinations must take place and a regression of the complaints must be prevented. In addition, the causative disease must be treated further until you can determine that you are free of symptoms. If the symptoms come back here, the prognosis worsens even more.
The human lung is a complicated organ that performs a vital function – absorbing oxygen from the air. For this reason, it is urgently necessary not to impair their function. The lungs can be damaged by a wide variety of influences.
In mediastinal emphysema, for example, an often irreversible enlargement of the smallest lung areas occurs. Basically, it is important to eliminate or prevent the causes of mediastinal emphysema, if this is possible. There is no other way to prevent mediastinal emphysema.
Follow-up visits for people with mediastinal emphysema are dependent on the severity of symptoms. In order to reduce the symptoms in the long term, individual follow-up care is agreed. To do this, it must be clarified whether there are previous illnesses that caused the condition – if these are treated accordingly and the patient shows recovery, the follow-up care in the case is sometimes complete.
In general, sport is considered an effective remedy for breathing problems, since the body is more resilient and the lung volume is trained. A so-called DMP (disease management program), which should be carried out once a quarter in a doctor’s office, provides information about the condition of the lungs and bronchi.
Drug treatment is sometimes necessary until the pressure in the mediastinal area subsides and has fallen to the desired values. So far, patients should take it easy and visit their doctor regularly to monitor the healing process more specifically. Exercise in the fresh air for at least an hour a day is recommended.
You can do that yourself
Mediastinal emphysema usually does not require treatment by the doctor or the patient. Normally, the air is absorbed by the surrounding tissue and any symptoms and complaints disappear as a result.
If high pressure builds up in the mediastinal area, therapy is indicated. A minimally invasive procedure is usually required. Surgery can best be supported by following the doctor’s instructions regarding dietary measures and physical activity. If complications arise, the most important measure is to see a doctor immediately. Self-treatment should be avoided in the event of shortness of breath or pain in the mediastinal area.
In the case of severe pain, drug therapy can often be supported by home remedies such as cooling and heat. Devil’s claw and other pain-relieving preparations are available from naturopathy. In any case, the patient should have the wound and the course of the mediastinal emphysema checked again by the doctor responsible. At the same time, the cause of the disease must be determined. In this way, the development of another mediastinal emphysema can be reliably avoided.