Spontaneous Mediastinal Emphysema with Bilateral Pneumothorax as a Complication of Bronchopneumonia

¹ "Rambam" Government Hospital.

The presentation and discussion of this case appears justified for the following reasons:

a) The rare occurrence of the syndrome;

b) The typical clinical findings which could lead to its correct diagnosis;

c) The possibility of a specific treatment consisting of the withdrawal of air from the pleural cavity in order to decrease the extent of the pneumothorax.

The marked release from discomfort, which the patient experienced following this intervention is astonishing, if compared to the comparative ease with which therapeutic pneumothorax is tolerated, even though the amount of air which is normally introduced is generally far greater than was found in this case. The explanation for this discrepancy is believed by us to be the simultaneous mediastinal emphysema, which causes compression of the heart, and thereby diminished cardiac output with resulting circulatory failure, together with the pressure exercised by the pneumothorax upon the distended mediastinum. We have no explanation for the blood pressure abnormality, which on repeated examinations at the time of admission was found to be similar to that seen usually in aortic insufficiency, arterio-venous fistula, etc., and which returned to normal later on.