Type:
Educational Exhibit
Keywords:
Respiratory system, Plain radiographic studies, Other, Eating disorders
Authors:
J. L. Del Bianco, L. Burgess
DOI:
10.26044/ranzcr2023/C-239
Imaging findings OR Procedure details
Spontaneous pneumomediastinum is a rare but life-threatening complication of anorexia nervosa and is often caused due to vomiting[1,2]. Although less common, there are cases reported which are not associated with vomiting[3,4]. This is postulated to be due to more fragile alveolar walls in malnourished anorexia nervosa patients[4,5,6]. Animal studies have shown that malnutrition and calorie restriction results in thinner alveolar walls and reduced number of alveoli[6]. Human post-mortem studies of Jewish victims of the Warsaw Ghetto, suffering from chronic starvation also found large alveoli and thinner alveolar walls[6,7].
It is uncommon for spontaneous pneumomediastinum to be the initial cause of presentation to healthcare facilities, with most cases described in the literature occurring in patients with known anorexia nervosa[7,8]. Spontaneous pneumomediastinum in anorexia nervosa is associated with significant morbidity and mortality if not effectively diagnosed[8,9]. This is due to not only the abnormal accumulation of gas, but also due to underlying anorexia nervosa and its medical complications[5].
Pneumomediastinum in the setting of an eating disorder must be distinguished from secondary pneumomediastinum due to oesophageal perforation[10]. Spontaneous pneumomediastinum in anorexia nervosa may persist longer than other causes of pneumomediastinum, and this is thought to be reflective of the severity the malnourished state[6,10]. Spontaneous pneumomediastinum can persist until the resolution of malnutrition[6,10].
Individuals with anorexia nervosa may avoid engaging with healthcare providers in order to avoid detection[3,11]. Medical complications of anorexia nervosa may lead such individuals to seek medical attention, therefore it is valuable to be able to recognise when a patient may be presenting with a potential complication of anorexia nervosa[3,11].