Spontaneous Pneumomediastinum Following Severe Vomiting in a Previously Healthy Young Adult

Spontaneous pneumomediastinum is an uncommon and generally benign condition that can present with acute chest pain and respiratory symptoms, often mimicking life-threatening cardiopulmonary or esophageal emergencies. Although frequently associated with asthma or coughing, severe vomiting is a less commonly recognized precipitating factor and poses a particular diagnostic challenge due to its overlap with esophageal perforation. We report the case of a previously healthy young adult who developed spontaneous pneumomediastinum following repeated episodes of forceful vomiting, presenting with retrosternal chest pain, dyspnea, subcutaneous emphysema, and a characteristic precordial crunch. Imaging studies confirmed the presence of mediastinal air without evidence of secondary causes, supporting a diagnosis consistent with alveolar rupture from increased intrathoracic pressure. The patient was managed conservatively with supportive care, resulting in complete clinical and radiologic resolution. This case underscores the importance of recognizing vomiting-induced spontaneous pneumomediastinum, maintaining a structured diagnostic approach to exclude more serious conditions, and avoiding unnecessary invasive interventions in clinically stable patients.