Management of spontaneous pneumomediastinum: Are hospitalization and prophylactic antibiotic treatment necessary?

Objective: Spontaneous pneumomediastinum is defined as the presence of free air in the mediastinum without concomitant disease. It is rare but usually benign and self-limiting. Usually, patients with spontaneous pneumomediastinum are hospitalised and sometimes prophylactic antibiotics are administered to prevent mediastinitis. The aim of this study was to investigate the feasibility of outpatient treatment and follow-up of spontaneous pneumomediastinum and the necessity of prophylactic antibiotics. Material and Methods: Patients with spontaneous pneumomediastinum between August 2020 and December 2023 were retrospectively evaluated. Patients with free air in the mediastinum on chest radiography or thorax computed tomography were accepted as SPM and included in the study. All case records were analysed in terms of demographic data, symptoms, triggering events, diagnostic studies, prophylactic antibiotic use, hospital stay and complications. Results: Of the 46 patients included in the study, 29 were male (63.1%) and 17 were female (36.9%). In terms of triggering event, 41.3% of the patients (19 of 46) did not have a specific triggering symptom (developed at rest). Asthma attack, physical exercise, cough (with or without upper respiratory tract infection), sneezing, labour, cold shower and sneezing were suspected triggering events. The mean duration of hospitalisation was 2.4 (2-5) days. Prophylactic oral antibiotherapy was administered in 18 (39.1%) patients. Complications such as tension pneumomediastinum, delayed pneumothorax, airway compression and mediastinitis did not develop in any patient. Conclusion: Spontaneous pneumomediastinum is a benign condition primarily seen in young adults with uneventful recovery. Our study supports the feasibility of outpatient treatment and follow-up in stable patients. However, in patients in whom the underlying disease requires special treatment and the possibility of mediastinitis or organ perforation cannot be ruled out, further diagnostic work-up, prophylactic antibiotics and inpatient treatment are necessary. Key words: "spontaneous pneumomediastinum", "complication", "hospitalisation", "antibiotic" Abstract Aim: Spontaneous pneumomediastinum is defined as the presence of free air in the mediastinum without concomitant disease. It is rare but usually benign and self-limiting. Usually, patients with spontaneous pneumomediastinum are hospitalised and sometimes prophylactic antibiotics are administered to prevent mediastinitis. The aim of this study is to describe practices regarding the feasibility of outpatient treatment and follow-up of spontaneous pneumomediastinum and the necessity of prophylactic antibiotics. Material and Method: Patients with spontaneous pneumomediastinum between August 2020 and December 2023 were retrospectively evaluated. Patients who showed free air in the mediastinum on chest radiography or thorax Computed Tomography were considered to have SPM and were included in the study. All case records were analysed for demographic data, symptoms, precipitating events, diagnostic studies, prophylactic antibiotic use, length of hospitalisation and complications. Results: Of the 46 patients included in the study, 29 were male (63.1%) and 17 were female (36.9%). In terms of triggering event, 41.3% of patients (19 of 46) did not have a specific trigger (at rest). Suspected triggering events included asthma attack, physical exercise, cough (with or without upper respiratory tract infection), sneezing, childbirth, shouting and sneezing. The mean duration of hospitalisation was 2.4 days. Prophylactic oral antibiotherapy was administered to 18 patients. No patient developed complications such as tension pneumomediastinum, delayed pneumothorax, airway compromise and mediastinitis. Conclusion: Spontaneous pneumomediastinum is a benign condition seen primarily in young adults with uneventful recovery. Our study supports the feasibility of outpatient treatment and follow-up in stable patients. However, in patients where the underlying disease requires special treatment and the possibility of mediastinitis or organ perforation cannot be excluded, further diagnostic work-up, prophylactic antibiotics and inpatient treatment are required.