Clinical Characteristics of Spontaneous and Recurrent Pneumomediastinum and Risk Factors of Recurrence
Chengbin Huang, Zhiyang Xu, Jianyang Wu, Junkai Xiong, Zhizhou Chen, Sheng Ouyang, Jianxin Xu, Jun GuanBackground
Spontaneous pneumomediastinum (SPM) is rare, and most existing knowledge comes from small case series. Although usually benign, SPM often leads to hospital admission and substantial healthcare resource use. This study aimed to characterize SPM and recurrent spontaneous pneumomediastinum (RSPM) in a large cohort and to explore factors associated with recurrence.
Methods
Patients with SPM hospitalized at Putian First Hospital between September 2011 and September 2023 were included. Clinical data were extracted from electronic medical records. Follow‐up was performed to identify RSPM. Patients were divided into nonrecurrence and recurrence groups, and risk factors for recurrence were evaluated using univariate logistic regression.
Results
A total of 135 patients with SPM were included. Most patients were male (78.1%), with a median age of 20 years (interquartile range [IQR]: 17–32). A bimodal age distribution was observed, with peaks at 15–19 and 50–54 years. The most common symptom was chest pain (51.9%), and 54.0% of the patients had no identifiable trigger. Among the 9 patients with RSPM (6.7%), median age at recurrence was 25 years (IQR: 16–56) and median interval to recurrence was 6.5 months (range: 1–16.5). Dyspnea was the most common symptom at recurrence (66.7%), and 44.4% of the patients showed greater clinical and radiological severity than at initial presentation. Univariate analysis suggested that a history of bronchitis was associated with RSPM (OR: 11.71, 95% CI: 1.68–81.89); other potential factors included silicosis, pneumonia, and upper respiratory infection as a trigger.
Conclusion
SPM predominantly affects young males and generally follows a benign course. Although recurrence is uncommon (6.7%), it may be more severe than the initial episode in nearly half of the cases. A history of bronchitis may be associated with recurrence, but this finding is exploratory. Age‐specific preventive strategies and careful exclusion of secondary pneumomediastinum are essential.