A peculiar case of asymptomatic spontaneous pneumomediastinum

To present a case of asymptomatic spontaneous pneumomediastinum and review available evidence-based workup and management.

A young Caucasian adult male with a history of inhalational drug use was admitted to the internal medicine service for evaluation of dehydration and mild rhabdomyolysis. Patient had been on the run from the police and had spent the last days prior to presentation without food, water, or shelter. On admission, patient had no complaints, except for thirst. It was detected on physical exam and chest x-ray that patient had subcutaneous emphysema and pneumomediastinum. The patient was treated conservatively and discharged after a period of observation.

Spontaneous pneumomediastinum is benign and seen primarily in young adults. It is more commonly associated with symptoms like chest pain and/or dyspnea, making an asymptomatic case particularly distinctive. The etiologies and precipitating factors are varied and often an apparent cause isn't identified. The diagnostic approach involves chest x-ray and/or computed tomography (CT) chest with further workup being largely unnecessary. The tenants of management include bedrest, analgesics, and supplemental oxygen as needed.