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Spontaneous pneumomediastinum: an uncommon clinical problem with a potential for missed or delayed diagnosis

Clare Treharne1, Holli Coleman2, Arunachalam Iyer2

  • 1ENT, University Hospital Monklands, Airdrie, UK clare.treharne1@nhs.net.

BMJ Case Reports
|February 2, 2021
PubMed

Insights

Forceful eructation can cause spontaneous pneumomediastinum, a rare condition presenting as facial and neck swelling. This case highlights the importance of clinical suspicion for this benign but unusual presentation.

Area of Science:

  • Gastroenterology
  • Thoracic Surgery
  • Radiology

Background:

  • Spontaneous pneumomediastinum is a rare condition characterized by the presence of air in the mediastinum without an apparent precipitating event.
  • While various causes exist, including forceful coughing or vomiting, pneumomediastinum following eructation is exceptionally uncommon.

Observation:

  • A 15-year-old male presented with acute facial and neck swelling after forceful eructation.
  • Physical examination revealed subcutaneous emphysema of the face and neck.
  • Imaging studies, including CT with oral contrast, confirmed extensive subcutaneous emphysema and pneumomediastinum involving the neck, thorax, and upper abdomen.

Findings:

  • The air leak's origin could not be identified despite thorough investigation, including upper gastrointestinal endoscopy.
  • The patient remained hemodynamically stable throughout the clinical course.
  • Repeated radiography demonstrated improvement, indicating a benign progression consistent with literature on similar conditions.

Implications:

  • This case represents the first reported instance of spontaneous pneumomediastinum attributed to forceful eructation.
  • Clinicians should maintain a high index of suspicion for pneumomediastinum in patients presenting with facial and neck swelling after forceful eructation.
  • Early recognition and conservative management are crucial for favorable outcomes in this rare condition.
Keywords:
healthcare improvement and patient safetyoesophaguspneumomediastinumsurgery

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