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Article
February 28, 1948

MEDIASTINOTOMY IN SPONTANEOUS MEDIASTINAL EMPHYSEMA

Author Affiliations

Baltimore

From the Departments of Medicine and Surgery, University of Maryland School of Medicine.

JAMA. 1948;136(9):622-623. doi:10.1001/jama.1948.72890260001008
Abstract

Mediastinal emphysema has been recognized as a clinical entity for over one hundred years, but it was not until 1937 that Hamman1 called attention to the spontaneous occurrence of this condition and the criteria necessary for its diagnosis. Since Hamman's lucid descriptions2 there have been reports of numerous cases. The majority of these have been self limited and of short duration. On rare occasions the accumulation of air in the mediastinum has been great enough to produce severe and sometimes fatal impairment of the circulatory system. When this occurs, immediate surgical intervention becomes necessary. The purpose of this report is to present a case of acute spontaneous mediastinal emphysema which required mediastinotomy.

PATHOGENESIS  In 1930, Joannides and Tsoulsos,3 while working with the problem of air embolism, noted the occurrence of mediastinal and interstitial emphysema and correctly speculated that anything producing increased intrapulmonic pressure could cause mediastinal emphysema.

References
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Hamman, L.:  Spontaneous Interstitial Emphysema of the Lungs ,  Tr. A. Am. Physicians 52:311-319, 1937.
2.
Hamman, L.:  Spontaneous Mediastinal Emphysema ,  Bull. Johns Hopkins Hosp. 64:1-21 ( (Jan.) ) 1939.
3.
Joannides, M., and Tsoulsos, G. D.:  The Etiology of Interstitial and Mediastinal Emphysema ,  Arch. Surg. 21:333-339 ( (Aug.) ) 1930.Crossref
4.
Macklin, C. C.:  Transport of Air Along Sheaths of Pulmonic Blood Vessels from Alveoli to Mediastinum: Clinical Implications ,  Arch. Int. Med. 64:913-926 ( (Nov.) ) 1939.Crossref
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Wallace, F. T.:  Acute Pulmonary Edema Associated with Mediastinal Emphysema ,  Surgery 19:430-433 ( (March) ) 1946.
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Schwartz, B. M.; McIlroy, G. H., and Warren, H. A.:  Acute Mediastinal Emphysema ,  Ann. Int. Med. 35:663-676 ( (Oct.) ) 1946.
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Morey, J. B., and Sosman, M. C.:  Spontaneous Mediastinal Emphysema ,  Radiology 32:19-22 ( (Jan.) ) 1939.
8.
Tiegel, M.:  Ein einfaches Verfahren zur Bekampfung des mediastinal Emphysems ,  Zentralbl. f. Chir. 38:420-423 ( (March) ) 1911.
9.
Hammond, A. E.:  Emergency Cervical Mediastinotomy in Case of Massive Mediastinal and Subcutaneous Emphysema Secondary to Removal of Foreign Body from Bronchus ,  Ann. Otol., Rhin. & Laryng. 53:829-836 ( (Dec.) ) 1944.
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