Pneumomediastinum Following Heimlich Maneuver

The Heimlich maneuver is a universally accepted, life-saving technique that expels airway obstructions by generating elevated intrathoracic pressure through a sudden, upward-directed epigastric compression. While generally safe, complications can occur. Pneumomediastinum, the presence of air within the mediastinum, is an uncommon but significant potential complication that arises from alveolar rupture and air tracking along bronchovascular sheaths due to sudden pressure changes. We present the case of a 27-year-old man with no significant medical history who presented to the emergency department with chest pain and dyspnea after choking on a piece of meat. His father performed multiple Heimlich maneuvers until the obstruction was relieved. He subsequently developed sharp, retrosternal chest pain radiating to the back, dyspnea, and two episodes of blood-streaked vomiting. Physical examination revealed subcutaneous emphysema in the right anterior triangle of the neck. His vital signs were stable. A chest radiograph demonstrated pneumomediastinum and subcutaneous emphysema. The patient was kept nil per os and received oxygen via nasal cannula, intravenous fluids, and empirical intravenous antibiotics. Computed tomography imaging confirmed pneumomediastinum without evidence of esophageal rupture. He was admitted for observation, managed conservatively, and discharged home after two days without complications. Pneumomediastinum is a rare but significant complication of the Heimlich maneuver. Clinicians should maintain awareness of this risk, ensure early recognition through clinical assessment and imaging, and pursue appropriate conservative management to achieve favorable outcomes. Education on proper technique may help reduce the risk of such complications.