Pneumothorax and Pneumomediastinum in Patients with Restrictive Eating Disorders: A Case Series and Literature Review

Journal of Clinical Case Reports
By Allison Nitsch, MD, FACP, CEDS Philip S. Mehler, MD, FACP, FAED, CEDS

Research Asset


Background: The purposes of this case series was to identify clinical characteristics of patients with restrictive eating disorders who have experienced pneumothorax or pneumomediastinum and elucidate possible risk factors for the development of pneumothorax or pneumomediastinum in this patient population through literature review. The scope of the case series is limited to patients admitted for medical stabilization from severe restrictive Eating Disorders (EDs).

Methods: We compiled a series of adult patients with severe EDs who were diagnosed with a pneumothorax or pneumomediastinum while admitted to the ACUTE Center for Eating Disorders at Denver Health between April 2016 and January 2021. Additionally, a series of adult patients who reported a history of pneumothorax on admission to the same institution, during the same time period, were identified and characteristics of their pneumothorax were obtained using outside records provided by the patient at time of their admission. A literature review of cases of pneumothorax and pneumomediastinum in patients with EDs was completed.

Results: Twenty-five cases of pneumothorax were identified in patients with anorexia nervosa (AN) or avoidant/restrictive food intake disorder (ARFID), all of whom were below normal body weight, between cases at our institution and literature review. Additionally, 5 patients at our institution, and 21 patients with EDs from the literature with below normal body weight with spontaneous pneumomediastinum were identified.

Conclusions and limitations: The relationship of spontaneous pneumomediastinum in patients with AN and ARFID and low body weights is well established and can be managed conservatively with good outcomes. It is currently unclear if the starved state, and the lung changes it induces in these patients increases patients’ risk for spontaneous pneumothorax. Patients with AN and ARFID may be at higher risk for iatrogenic pneumothorax with certain invasive procedures. There is direct connection between patients’ eating disorder and occurrence of traumatic pneumothorax. Patients at expected body weights, or in larger bodies with restrictive Eds, were not included in this study and therefore, their risk of pneumothorax and pneumomediastinum in relation to their eating disorder behaviours is unknown.

Written by

Allison Nitsch, MD, FACP, CEDS

Dr. Allison Nitsch obtained her Bachelors degree in Chemical Engineering from The University of Texas at Austin. She then matriculated to Texas A&M Health Science Center where she completed her…
Written by

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Philip S. Mehler began his career at Denver Health more than 35 years ago and was formerly its Chief of Internal Medicine and then Denver Health’s Chief Medical Officer (CMO) until he was promoted…

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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