[A case of spontaneous pneumomediastinum in a trombonist]

A case of spontaneous mediastinal emphysema in a 21-year-old female trombonist was reported. During light work, she experienced pain in her neck which later radiated into her chest. She had neither causal disease nor episode of straining at the onset of her work. On admission, physical examination revealed subcutaneous emphysema over the upper part of the chest and neck, and mediastinal crunch on auscultation (Hamman's sign). Roentgenograms revealed the presence of a considerable amount of air in the mediastinum and this extended upward through the mediastinum into the soft tissue of the neck bilaterally. The chest and neck CT yielded clearer information concerning the location and degree of mediastinal emphysema. She was treated with bed rest and recovered completely within five days. Spontaneous mediastinal emphysema without causal disease or apparent precipitating episode is infrequently recognized. In our case, though the trombonist had no apparent straining episode, the causative factor can be assumed to be the tenderness of the alveoli originating from frequent over-inflations of the lungs and high intra-alveolar pressures of about 150 cmH2O during trombone performance, which may result in alveolar rupture under normal intralveolar pressures.