When Asthma Leads to Air: Pneumomediastinum in a Child

Background: Pneumomediastinum is a clinical condition characterized by the presence of free air within the mediastinum. Methods: We report the case of a 12-year-old boy with recurrent wheezing who developed pneumomediastinum associated with pneumorrhachis during a Rhinovirus-triggered asthma exacerbation, in the context of a family history of spontaneous pneumothorax, alongside a literature review covering the past ten years. Results: Laboratory tests were unremarkable, except for neutrophilia and a positive Rhinovirus test. Chest X-ray revealed a large pneumomediastinum, extending into cervical soft tissues, and CT confirmed pneumorrhachis. The patient was treated with oxygen, bronchodilators, corticosteroids, and antibiotics due to concern for esophageal injury, and he was discharged after six days with complete resolution on follow-up. Pediatric pneumomediastinum is rare but usually benign. Respiratory diseases, particularly asthma, are among the most frequent predisposing conditions. Diagnosis relies on clinical assessment and chest imaging, while management is mainly conservative. Conclusions: Timely intervention is essential in the care of children with pneumomediastinum. Accurate diagnosis and optimal management of asthma are essential not only to control symptoms but also to prevent potential serious complications. This case highlights the occurrence of pneumorrhachis as an uncommon radiological finding associated with asthma-related pneumomediastinum and provides an updated review of recent pediatric evidence.