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Background Guidelines to standardize treatment and follow-up strategies in pneumomediastinum cases are lacking. The aim of the study was to evaluate the etiology in pneumomediastinum cases and the results of treatment and follow-up. Results Nineteen patients with pneumomediastinum who were followed up in our clinic between 2015 and 2020 comprised the study population. Among the patients, 16 (84.2%) were male, and the mean age was 31.15 years. The chief presenting complaints were chest pain and dyspnea. Pneumomediastinum was spontaneous in 15/19 patients (including spontaneous pneumomediastinum with an underlying pathology in 3/15), traumatic in 3/19, and iatrogenic in 1/19. Spontaneous pneumomediastinum without underlying pathology was seen in younger adults (mean age: 23 years). Surgical intervention in traumatic and iatrogenic pneumomediastinum cases was compared with spontaneous cases and no statistically significant difference was observed ( p =0.178). The mean hospital stay of all patients was 3.15 days. Only one patient had a recurrence and died, which was later determined to be a secondary spontaneous pneumomediastinum case. Conclusion Pneumomediastinum often occurs with an underlying pathology in advancing age and as spontaneous in younger patients. Therefore, “secondary spontaneous pneumomediastinum” subclass should be evaluated in the classification to facilitate to create a standard guideline and prevent overdiagnosis and overtreatment.

Pneumomediastinum: retrospective analysis of 19 cases and an innovation proposal in classification