The extensive literature on the subject of mediastinal emphysema has been reviewed in detail by Jessup1 and Macklin and Macklin.2 Mediastinal empysema may complicate such conditions as chest trauma, general anesthesia, various surgical procedures, straining, parturition, esophageal or duodenal perforation, therapeutic pneumothorax or pneumoperitoneum, bronchopneumonia, tracheobronchitis, laryngitis, diphtheria, pulmonary tuberculosis, asthma, pulmonary emphysema, peroral endoscopy, and tracheobronchial foreign body. Occasionally the condition occurs apparently without predisposing pathology, although frequently in such cases there is a history of straining or severe coughing.
The mechanisms involved in the production of mediastinal emphysema differ. The condition may follow perforation of a hollow organ such as the esophagus, under which circumstances the emphysema is rarely extensive. Tracheal or bronchial perforation or rupture may produce an alarmingly extensive degree of emphysema. Wounds of the chest wall accompanied by bronchopleural communication may be followed by extravasation of air from the pleural cavity into the
Pecora DV, Yegian D, Hochwald A. TRACHEOTOMY IN THE TREATMENT OF SEVERE MEDIASTINAL EMPHYSEMA. JAMA. 1958;166(4):354–356. doi:10.1001/jama.1958.62990040004008a
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