Aims Pneumomediastinum is a known radiological finding after major thoracic trauma; however, its significance and required investigative workup are not standardized. Furthermore, there is little evidence to suggest that traumatic pneumomediastinum is indicative of oesophageal injury. Our study sets out to investigate the incidence of oesophageal injury for these patients at our centre, and the relevant investigative workup is required. Methods Medical records were retrieved from our trust (Major Trauma Centre: 2012 to present, Upper Gastro-Intestinal (UGI) Centre: 2009 to present) to include trauma patients with radiological pneumomediastinum admitted between 2010 and 2021. Demographics, mechanism of injury, length of stay, and other significant findings were collected retrospectively using the electronic patient record. Results The data search retrieved 37 patients with traumatic pneumomediastinum. One patient was excluded due to incomplete records. Road traffic collisions were the most common presentation (18 patients), followed by falls (13 patients), penetrating trauma (three patients), assault (two patients), and workplace injury (one patient). The median length of stay was six days, with two inpatient deaths. One patient had a confirmed tracheobronchial injury on initial imaging which was managed conservatively, while six other patients underwent further oral contrast CT for suspected oesophageal injury. No patients in our dataset had a confirmed oesophageal injury. Conclusion Oesophageal injury is rarely seen in traumatic pneumomediastinum and is usually secondary to other chest injuries causing an air leak into the mediastinum. Oral contrast CT is the recommended investigation to exclude oesophageal injury.
Keywords: acute care surgery and trauma; general trauma surgery; major trauma; surgery of the oesophagus; upper gastrointestinal surgery.
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