Spontaneous pneumomediastinum (SPM) is an uncommon disorder with a small number of reported clinical studies. The goal of this study was to investigate the clinical manifestations and natural course of SPM and the currently available treatment options. We retrospectively reviewed 91 patients diagnosed with SPM between January 2008 and June 2015. The mean age of the patients was 22.7 ± 13.2 years, and 67 (73.6%) were male. Chest pain (58, 37.2%) was the predominant symptom. The most frequent precipitating factor before developing SPM was the patient’s cough (15.4%), whereas the majority of patients (51, 56.0%) had no precipitating factors. Chest X-ray was diagnostic in 44 (48.4%) patients, and chest computed tomography showed mediastinal air in all cases. Esophagography (10, 11.0%), esophagoduodenoscopy (1, 1.1%), and bronchoscopy (5, 5.5%) were performed selectively due to clinical suspicion, but no abnormal findings that implicated organ injury were documented. Twelve patients (13.2%) were discharged after a visit to the emergency room, and the others were admitted and received conservative treatment. The mean hospital stay was 3.0 ± 1.6 days. There were no complications related to SPM except recurrence in two (2.2%) patients. SPM responds well to conservative treatment and follows a benign natural course. Hospitalization and aggressive treatment can be performed in selective cases.
