Do we need an esophagram to evaluate a spontaneous pneumomediastinum in kids?

The paper was published in JPS a few days after the subject was brought up amongst our group.  Basically, what do we do with a kiddo who presents with a pneumomediastinum with no antecedent history of trauma or retching, and who is otherwise doing well with no fever or signs of mediastinitis.

In this paper, the authors retrospectively reviewed 27 patient with a spontaneous pneumomediastinum(SPM) who underwent an esophagram as part of their evaluation. The authors noted that none of the patient had a demonstrable injury to the esophagus. They concluded that an esophagram is not necessary for the evaluation of SPM. They felt the source of the air in this group of patients was alveolar disruption and not an esophageal injury.

Needles to say, a series of 27 patients is not sufficient to make a final conclusion on the subject. That being said, the series helps us support any decision we make regarding clinical follow up on a patient with a SPM, who is otherwise well with no other signs of esophageal injury such as dysphagia or pleural effusion on a CXR.