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MEDIASTINOTOMY IN SPONTANEOUS MEDIASTINAL EMPHYSEMA

JAMES R. KARNS, M.D.; EDWIN O. DAUE Jr., M.D.
JAMA. 1948;136(9):622-623. doi:10.1001/jama.1948.72890260001008.
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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.

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