Purpose or Case Report: Pneumomediastinum is a radiological finding that may be seen following thoracic trauma, yet its importance and follow-up imaging recommendations are not standardized. Additionally, there is limited evidence linking traumatic pneumomediastinum to injury that will require treatment.

To evaluate the rate of the positivity of esophagrams performed for post-traumatic pneumomediastinum and to determine the appropriate investigative procedures needed.
Methods & Materials: This single-center, retrospective review included pediatric patients presenting with blunt chest trauma to our facility between 6/30/2019 - 7/1/2024. Patients presenting to the emergency department were identified using the diagnostic code J98.2 (pneumomediastinum). Exclusion criteria included pneumomediastinum without associated trauma, including cough, vomiting, or possible esophageal foreign body.

The electronic medical records were also reviewed to obtain demographic and clinical data including age, gender, weight, past medical history, mechanism of trauma, presentation characteristics, imaging findings and hospital management.
Results: Eighteen patients met inclusion criteria. All patients had pneumomediastinum confirmed at chest CT and all patients underwent a subsequent fluoroscopic esophagram following CT. Mechanisms of injury (in order of frequency), included sport-related injuries (7), Fall from height (6), dirt bike/ATV (3), and MVC (2). No patients presented with symptoms related to esophageal injury, including no dysphagia, odynophagia, or difficulty swallowing secretions. None of the 18 esophagrams demonstrated evidence of esophageal injury.
Conclusions: In this study, we demonstrated a positivity rate of 0% for esophagrams performed to evaluate for esophageal injury as the etiology of pneumomediastinum following blunt thoracic trauma. Although further studies with larger sample sizes are needed, we propose that esophagrams are not indicated in patients who present in this manner who are otherwise asymptomatic, and trauma guidelines should therefore be appropriately updated.