Respiratory syncytial virus: not only bronchiolitis in infants

Spontaneous pneumomediastinum is defined as free air or gas contained within the mediastinum. It originates from the rupture of alveolar space because of high pressures. The incidence of spontaneous pneumomediastinum in pediatrics is between 1/8000 to 1/15 000 with two age peaks; under 4 years old and between 13 to 17 years old. First group is characterized by being secondarily accompanied by an infection of the respiratory tract, asthmatic exacerbation or foreign body aspiration while the second one usually originates after intense physical activity. Influenza or bocavirus have been related with the pathology of this entity, but few cases have been written in relation to respiratory syncytial virus. The most common symptoms are chest pain and dyspnea with subcutaneous emphysema as a characteristic sign. Diagnosis in almost all cases will be given by a chest X-ray. Management will depend on the degree of involvement and its repercussion, which will spread from observation to admission to the ICU. Conservative therapy and treatment of associated complications are usually sufficient, there are few recurrences and the prognosis is good in most of cases.