Issue: 2007 > November > review

Mediastinal emphysema complicating diabetic ketoacidosis: plea for conservative diagnostic approach

R.G. Pauw, T.S. van der Werf, H.M. van Dullemen, R.P.F. Dullaart


Background: Spontaneous pneumomediastinum has been infrequently reported as a complication of diabetic
ketoacidosis. Evidence-based guidelines are currently not
available to help in choosing the best diagnostic approach.
Methods: We conducted a systematic review of the literature and looked for diagnostic clues that might indicate the need for a work-up to rule out oesophageal perforation.
Results: In all 56 published cases of spontaneous
pneumomediastinum associated with diabetic ketoacidosis, the condition was self-limiting. We report one additional case of a 31-year-old female who presented with a spontaneous pneumomediastinum and also epidural pneumatosis, complicating diabetic ketoacidosis.
Conclusion: Important pathology, such as oesophageal
rupture, was not detected in any of the reported cases, and we suggest a restrictive diagnostic work-up.