• Muckart David James Jackson DJJ Department of Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congella, KZN, South Africa. , Timothy Craig Hardcastle, and David Lee Skinner.
• Department of Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congella, KZN, South Africa.
• Eur J Trauma Emerg Surg. 2019 Oct 1; 45 (5): 927-931.

PurposePneumomediastinum is the hallmark of intrathoracic aerodigestive trauma, but rare following blunt injury.Aimreview of blunt thoracic trauma (BTC) for the incidence and outcome of patients with pneumomediastinum or pneumopericardium (PM/PC) on Computerised Tomographic scanning.MethodsAdmissions to the level I trauma ICU at IALCH, Durban, ZA following BTC from April 2007 to March 2014. Patients with Chest-CT-scan were analysed. Variables included age, sex, mechanism of injury, and Injury Severity Score (ISS). Specific injury patterns: isolated thoracic trauma, flail chest, bilateral injury and presence of haemothorax or pneumothorax were analysed.ResultsThree hundred and eighty-nine patients were included. Males (70.9%) accounted for the majority of patients. The median Injury Severity Score was 32 (IQR 24-41). Motor vehicle collisions accounted for 94% of injury mechanisms. Twenty-three (5.9%) were identified with pneumomediastinum, 6 (1.5%) with both pneumomediastinum and pneumopericardium, and 1 (0.2%) with isolated pneumopericardium. No patient required surgery for thoracic trauma. Increasing age (p < 0.001) and a flail chest (p = 0.005) were significant associations. The mortality rate was almost identical in those with or without air within the mediastinum. No patient died from a missed mediastinal aero-digestive injury.ConclusionThe presence of PM/PC following BTC is incidental and benign. Increased injury severity with a flail chest is associated with a significant increase in the presence of free gas within the mediastinum. In the absence of complications, no obvious injury to the intrathoracic aero-digestive tract on CT scanning, and no difference in mortality, a conservative management policy is warranted.

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