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(Chest. 2000;117:1809-1813.)
© 2000 American College of Chest Physicians

Persistent Pneumomediastinum in Interstitial Fibrosis Associated With Rheumatoid Arthritis*

Treatment With High-Concentration Oxygen

Anshul Patel, BS; Branko Kesler, MD and Robert A. Wise, MD, FCCP

* From Johns Hopkins University, School of Medicine at the Johns Hopkins Asthma and Allergy Center, Division of Pulmonary and Critical Care Medicine, Baltimore, MD.

Correspondence to: Robert A. Wise, MD, FCCP, Johns Hopkins University, School of Medicine at the Johns Hopkins Asthma and Allergy Center, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224; e-mail: rwise{at}welch.jhu.edu

We present a case of persistent spontaneous pneumomediastinum precipitated by an upper respiratory infection in a patient with interstitial fibrosis associated with rheumatoid arthritis who was receiving chronic corticosteroid treatment. The persistent nature of the mediastinal emphysema over 2 months eventually required treatment with high concentrations of inhaled oxygen that resulted in rapid resolution of the pneumomediastinum without recurrence over 6 months of follow-up. This case, along with others in the medical literature, emphasizes the need for early use of high-concentration inhaled oxygen in the treatment of pneumomediastinum in high-risk patients, such as those with connective tissue disorders.

Key Words: oxygen therapy • pneumothorax • pulmonary fibrosis • rheumatoid arthritis • spontaneous pneumomediastinum




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