Idiopathic Spontaneous Pneumomediastinum in an Adolescent

Abstract

Idiopathic spontaneous pneumomediastinum (ISPM) is a diagnosis of exclusion after a spontaneous pneumomediastinum (SPM) occurs without any identifiable predisposing factors or known aetiology. It is a rare diagnosis in adolescents, with a few cases reported in the literature. To increase awareness of this rare diagnosis, we present a case of a 17-year-old, fit and healthy male who presented with acute atraumatic chest pain. On examination, surgical emphysema in the supraclavicular fossa was identified. His chest X-ray and a subsequent computed tomography (CT) of the thorax showed extensive pneumomediastinum, with infiltration of air into the soft tissues of the neck and upper arms, but with no identifiable cause. On followup, he remained asymptomatic, and a repeat CT of the thorax four weeks after his initial presentation showed complete resolution of the pneumomediastinum. Once confirmed, ISPM is expected to resolve spontaneously without complications, with a very low rate of recurrence in nearly all cases.

Spontaneous Pneumomediastinum: A Rare Cause of Chest Pain

“…The symptoms associated with this condition can vary from being completely without symptoms to severe or even life-threatening cases [ 1 , 6 ]. The most frequent symptom reported was chest pain, present in about 70% of the cases, and dyspnea [ 7 , 8 ]. Chest pain is typically located centrally and can mimic myocardial infarction or pericarditis, being exacerbated by movements, deep breathing, and relief by leaning forward while sitting [ 8 , 9 ].…”

“…Air bubbles or extensive air collections can be observed outlining mediastinal blood vessels, large airways, the esophagus, or even the heart, and the presence of interstitial emphysema is helpful in confirming a pneumomediastinum diagnosis. The anteroposterior chest radiograph view may show a "continuous diaphragm sign" when air is present in this space between the heart and the upper surface of the diaphragm [ 7 , 12 ]. Typically, the central part of the diaphragm cannot be seen in images due to its proximity to the heart, given that both structures have a similar radiological density [ 12 ].…”

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department

“…Pulmonary system-related chest pain is also not highly prevalent, accounting for 1.82–12.78% [ 1 , 9 , 12 , 14 , 15 , 16 , 17 , 31 ], with common causes including pneumothorax, asthma, pneumonia, and the less common pneumomediastinum [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Some of these diseases can be potentially life-threatening, such as tension pneumothorax.…”

Spontaneous Pneumomediastinum in a Middle-Aged Female Patient With Schizophrenia: A Case Report

“…Spontaneous pneumomediastinum (SPM) is a rare condition wherein air is present in the mediastinum without a significant cause, primarily affecting young males [ 1 ]. The mechanism of SPM is thought to be that the alveoli rupture because of increased intrathoracic pressure, and air accumulates in the mediastinum along the bronchi.…”

“…The mechanism of SPM is thought to be that the alveoli rupture because of increased intrathoracic pressure, and air accumulates in the mediastinum along the bronchi. The symptoms are often ambiguous, such as chest pain, neck pain, and difficulty swallowing, making diagnosis difficult [ 1 ]. We examined a middle-aged female patient with schizophrenia whose neck pain and dysphagia were caused by SPM.…”