Are esophagrams indicated in pediatric patients with spontaneous pneumomediastinum?

BACKGROUND/PURPOSE: Spontaneous pneumomediastinum is an infrequent condition in pediatric patients. Presenting symptoms include chest pain, dysphagia, or vomiting, without initiating event. Patients may undergo esophagram because of concern for esophageal perforation as the source for pneumomediastinum, however, abnormalities are rarely demonstrated. The objective of this study is to identify whether esophagrams performed on pediatric patients for spontaneous pneumomediastinum are warranted.

METHODS: An IRB approved, retrospective study was performed. The radiology information system was queried for the keyword "pneumomediastinum" in reports from 2000 to 2016. 27 patients were identified with spontaneous pneumomediastinum, who underwent 28 esophagrams, and 18 patients with pneumomediastinum secondary to blunt trauma, undergoing 20 esophagrams. Imaging findings recorded included presence of pneumothorax or pleural effusion, amount of imaging performed, radiation dose and fluoroscopy time for esophagrams, and type of contrast used. Clinical data recorded included presenting symptoms, presence of fever, and length of hospital stay.

RESULTS: All esophagrams in patients with both spontaneous and post traumatic pneumomediastinum were negative. Patients were exposed to radiation doses between 61 and 92 μGy m2 during esophagrams. Contrast aspiration occurred in one patient.

CONCLUSIONS: Esophagrams are not indicated for pediatric patients with spontaneous pneumomediastinum, and may not be warranted in patients with post traumatic pneumomediastinum.