Clinical investigation of 19 cases of ?spontaneous pneumomediastinum ?complicated with? interstitial lung disease

Introduction: Spontaneous pneumomediastinum (SPM) is a rare complication of interstitial lung disease(ILD), and little is know about clinical features of SPM. Objective: This study was performed to determine the prognosis of SPM in ILD patients. Patients and Method: We retrospectively evaluated the clinical factors of 19 cases with SPM in ILD patients diagnosed by CT at Katsushika Medical Center from August 1, 2013, to August 31, 2018. Result: Characteristics of 19 cases were 11 men and 8 females with a mean age 76.9 years, and 7 cases having a smoking history. Main complaints at the episode of  SPM  were as follows: respiratory distress in 9 cases, abdominal pain in 2, coughing, cervical discomfort in 2, tachycardia in 1, and hypophagia in 1, respectively, and other 3 cases had no chief complaints. Four cases complicated pneumothorax at the onset of SPM. The details of  ILD  were  11 cases of  idiopathic pulmonary fibrosis and 8 cases of NSIP, and 10 cases on drug therapy for ILD; steroid treatment in 8 cases and antifibrotic drugs in 2 cases. Treatments  for  SPM  were  rest-cure in 10 cases, antibiotic therapy in 3 cases, oxygen administration in 1 case, steroid medication in 1 case.   The median observation period from onset of SPM was 168.0 days (±337.7SD). There were  9 cases (47.3%) of deaths during the observation period, the median duration from the  onset  of SPM to death was 110.0 days  (±469.9SD), and the mean age at death was 79.5 years. Six  cases died of the progress of IP, 2 cases of pulmonary infectious diseases and 1 case is unknown in detail of elapse to the death. Conclusion: We concluded that SPM is a poor prognostic factor.