Spontaneous pneumomediastinum (SPM) is a rare disorder most often affecting young males which is generally self-limiting. Despite the benign prognosis with few complications and little morbidity, it frequently confuses clinicians in primary settings, who may have difficulty differentiating SPM from other serious organ ruptures, especially oesophageal rupture (the so-called Boerhaave syndrome), which may lead to mediastinitis and may be fatal, even with appropriate interventions. An overview of adult SPM is provided, reviewing 17 studies (414 patients), including our clinical experience, and finally an algorithm for diagnosis and management of SPM is proposed, based on the characteristics of SPM.

A 63-year-old woman presented with abnormal vaginal bleeding. Her disease history was significant, and included advanced lung adenocarcinoma with a deletion mutation in exon 19 of the epidermal growth factor receptor (EGFR) gene, which was managed by concurrent chemoradiotherapy, followed by molecular targeted therapy with tyrosine kinase inhibitors (TKIs) for a two-year period. Contrast-enhanced computed tomography showed the enlargement of a previously suspicious myoma node, with peripheral enhancement. Hemorrhagic necrosis was also observed on magnetic resonance imaging. Transabdominal hysterectomy and bilateral salpingo-oophorectomy showed solitary intramyometrial metastatic lung adenocarcinoma with a second-site T790M gatekeeper mutation in exon 20 of the EGFR gene. In conclusion, uterine metastasis from lung adenocarcinoma can present a diagnostic challenge. The possibility of lung cancer metastasis should be considered when a uterine mass increases in size during treatment. Molecular analysis of the EGFR gene to detect mutations could provide useful information for planning the treatment strategy.

Ratonale:Sometimes, pleural effusion accompanying an acute Mycoplasma pneumoniae infection or tuberculous pleurisy has similar analysis results. We report a case of tuberculous pleurisy which was initially diagnosed as acute M pneumoniae infection, which is of special interest because anti-Mycoplasma antibody results were positive, which served as a red herring.Patient concerns:A 20-year-old woman visited the outpatient emergency romm of our hospital for chief complaints of high fever, dry cough, and pleuralgia persiting for 2 days. Since anti-mycoplasma antibody test results were positive, we treated acute M pneumoniae infection and drained her pleural effusion. The condition tended to improve, but on day 16 postadmission, the acid-fast bacterial culture of the pleural effusion was positive for Mycobacterium tuberculosis.Diagnoses:Tuberculous pleurisy.Interventions:After the diagnosis, the patient received antituberculous drugs.Outcomes:She completed treatment with no noticeable adverse events, and the right pleural effusion disappered and diffuse right pleural thickening improved.Lessons:Exudative pleural effusion with lymphocyte dominance and a high adenosine deaminase level in M pneumoniae infection have been reported. Even though the condition suggests acute M pneumoniae infection, clinicians should be aware that tuberculous pleurisy and M pneumoniae infection can share similar clinical features, and should understand the usefulness and limitations of the anit-Mycoplasma antibody test.

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A 71‐year‐old woman was referred to our department due to an abnormal chest shadow. Imaging revealed a pulmonary nodule shadow in the left S6 segment, multiple small nodule shadows in the left pleura, and left pleural effusion. Transbronchial biopsy using endobronchial ultrasonography (EBUS) with a guide sheath was conducted. EBUS showed the probe of the sheath located in the lesion and biopsy was performed in this area. A yellow turbid fluid appeared in the sheath and vacuum aspiration resulted in collection of 200 mL of this fluid. We suspected that drainage occurred because the sheath tip had ruptured the pleural cavity. The pathological diagnosis was adenocarcinoma. It is likely that the EBUS images reflected pleural effusion adjacent to the lesion, and that the complication occurred because the biopsy was performed without awareness of these findings. This complication may be prevented by closer examination of echo findings and rotation of the X‐ray source to ensure performance of the biopsy directly under the pleura.