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Communications to the Editor |

Pneumomediastinum Following Spirometry FREE TO VIEW

Jane Krasnick, MD
Author and Funding Information

Bloomfield Hills, MI

Correspondence to: Jane Krasnick, MD, Allergy and Asthma Specialists of Bloomfield Hills, 43750 Woodward, Suite 101, Bloomfield Hills, MI 48302; e-mail: jbkrasnick@aol.com



Chest. 2001;120(3):1043. doi:10.1378/chest.120.3.1043
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To the Editor:

Spirometry is a simple and common procedure performed to access pulmonary lung function. Complications from testing are rare but can include dizziness from hyperventilation, and vasovagal reactions. The development of pneumomediastinum following spirometric testing has also been previously reported in two normal subjects12 and in one immunocompromised patient with presumed Pneumocystis carinii pneumonia.3

Patients undergoing spirometry are instructed to take a deep inspiration to total lung capacity and then to expire vigorously. This causes a rapid increase in lung volume and pressure changes in the alveolus. These sudden changes in alveolar volume and transpulmonary pressure can lead to alveolar rupture and subsequent air entry into the bronchovascular sheath.4

We report a 32-year-old white man who developed a pneumomediastinum after undergoing spirometry. The patient had a history of perennial allergic rhinosinusitis and had complained of vague and intermittent upper-chest tightness for several months. He denied any gastric reflux symptoms.

Spirometry was performed before and after administration of nebulized levalbuterol hydrochloride (0.63 mg) and findings were normal. Two hours later, he developed severe throat and neck pain. He also had a change in his voice to a high-pitched voice. Physical examination noted palpable crepitus in the neck. A high-resolution CT scan of the chest was obtained to excluded underlying parenchymal lung disease. The only abnormality was the pneumomediastinum (Fig 1). All symptoms resolved within 36 h. The chest radiograph finding was normal 5 days later.

Although spirometry is a safe and useful test, one should be aware of the physiologic changes that occur in the respiratory tract with the vigorous straining required to complete the test. Furthermore, one should suspect pneumomediastinum as a complication if the patient complains of severe neck or throat pain following the procedure.

Figure Jump LinkFigure 1. Figure 1. High-resolution CT scan of the chest shows extensive emphysematous changes in the mediastinum. The air extends to encase the trachea, esophagus, arch vessels, and thyroid.Grahic Jump Location
Manco, JC, Terra-Filho, J, Silva, GA (1990) Pneumomediastinum, pneumothorax and subcutaneous emphysema following the measurement of maximal expiratory pressure in a normal subject.Chest98,1530-1532. [PubMed] [CrossRef]
 
Varkey, B, Kory, RC Mediastinal and subcutaneous emphysema following pulmonary function tests.Am Rev Respir Dis1973;108,1393-1396. [PubMed]
 
Ramakrishnan, S, MacLeod, PM, Tyrell, CJ Spontaneous subcutaneous mediastinal emphysema: a complication of lung function tests inPneumocystis cariniipneumonia.Postgrad Med J1988;64,960-962. [PubMed]
 
Park, DR, Pierson, DJ Pneumomediastinum and mediastinitis. Murray, JF Nadel, JA eds.Textbook of respiratory medicine 3rd ed.2000,2095-2121 W. B. Saunders. Philadelphia, PA:
 

Figures

Figure Jump LinkFigure 1. Figure 1. High-resolution CT scan of the chest shows extensive emphysematous changes in the mediastinum. The air extends to encase the trachea, esophagus, arch vessels, and thyroid.Grahic Jump Location

Tables

References

Manco, JC, Terra-Filho, J, Silva, GA (1990) Pneumomediastinum, pneumothorax and subcutaneous emphysema following the measurement of maximal expiratory pressure in a normal subject.Chest98,1530-1532. [PubMed] [CrossRef]
 
Varkey, B, Kory, RC Mediastinal and subcutaneous emphysema following pulmonary function tests.Am Rev Respir Dis1973;108,1393-1396. [PubMed]
 
Ramakrishnan, S, MacLeod, PM, Tyrell, CJ Spontaneous subcutaneous mediastinal emphysema: a complication of lung function tests inPneumocystis cariniipneumonia.Postgrad Med J1988;64,960-962. [PubMed]
 
Park, DR, Pierson, DJ Pneumomediastinum and mediastinitis. Murray, JF Nadel, JA eds.Textbook of respiratory medicine 3rd ed.2000,2095-2121 W. B. Saunders. Philadelphia, PA:
 
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