Spontaneous Pneumomediastinum in a Patient With Asthma: A Case Report

Pneumomediastinum is described as free air located within the mediastinum. In the absence of traumatic injury, iatrogenic injury, or a clear etiology, it is called spontaneous pneumomediastinum (SPM). SPM has been associated with many conditions and triggers, including bronchial asthma, forceful straining during exercise, inhalation of drugs, and activities associated with the Valsalva maneuver. This case details a 25-year-old female patient with a past medical history of asthma who presented to the emergency department with cough, shortness of breath, and chest pain. Initial chest X-ray demonstrated subcutaneous emphysema of the lower neck, and subsequent CT revealed extensive pneumomediastinum. The patient was admitted and treated for an acute asthma exacerbation with bronchodilators, corticosteroids, and analgesics. Supplemental oxygen was administered to facilitate nitrogen washout, and serial chest radiographs were obtained to monitor for progression or development of pneumothorax. The patient's respiratory symptoms improved, pulmonary function stabilized, and follow-up imaging demonstrated interval improvement of the pneumomediastinum without complications. This case highlights the importance of recognizing SPM as a potential complication of asthma exacerbations and emphasizes the role of supportive management and monitoring.