Young man with Spontaneous Pneumomediastinum with Atypical Presentation


1 School of Medicine, Mashhad University of Medical Sciences, IR Iran

2 Department of Emergency Medicine, Mashhad University of Medical Science, Iran .


Introduction: Spontaneous pneumomediastinum (SPM) is a rare condition that is defined as the presence of free air in the mediastinal structures without underlying cause. It commonly happens after coughing, vomiting or intensive physical exercise. Most patients present to emergency department (ED) with dyspnea and chest pain. Young healthy adults are the most population that involve with this problem. Chest X-ray and Chest CT are modalities that can be used for approving the diagnosis. Although SPM seldom accompany with life threatening complications, it is usually a benign and self-limiting disorder. Here we introduce a patient with spontaneous pneumomediastinum with atypical presentation. Case Presentation: A 19-year-old man presented to ED with chief complaint of dyspnea without chest trauma. He denied any drugs consumption and his past medical history did not have noticeable problems. Patient’s vital signs were normal and in physical examination, except mild emphysema of neck, other system inspection did not have any pathologic findings correspond with his complication. Chest X-ray and chest CT scan exhibited air in mediastinum without any other pathology like rib fracture. After three days his symptoms was resolved with no requiring to specific treatment. Conclusion: It is a rare condition and if it present with rare symptoms the diagnosis would be very difficult. More, physical examination and chest x-ray as the first diagnostic imaging in respiratory complaints may detect no obvious findings. SPM should be considered as differential diagnosis in young adults, with any respiratory complaint.


  1. Al-Mufarrej F, Badar J, Gharagozloo F, Tempesta B, Strother E, Margolis M. Spontaneous pneumomediastinum: diagnostic and therapeutic interventions. J Cardiothorac Surg. 2008;3(1):59. doi: 10.1186/1749-8090-3-59. [PubMed: 18980688].
  2. Potz BA, Chao  LH,  Ng  TT,  Okereke  IC.  Clinical  significance  of spontaneous pneumomediastinum. Ann Thorac Surg. 2017;104(2):431-5. doi: 10.1016/j.athoracsur.2017.02.051. [PubMed: 28527963].
  3. Bakhos CT, Pupovac SS, Ata A, Fantauzzi JP, Fabian T. Spontaneous pneumomediastinum: an extensive workup  is not required. J Am Coll Surg. 2014;219(4):713-7. doi: 10.1016/j.jamcollsurg.2014.06.001. [PubMed: 25053221].
  4. Turban JW. Spontaneous pneumomediastinum from running sprints. Case Rep Med. 2010;2010:977467. doi: 10.1155/ 2010/927467. [PubMed: 20862351].
  5. Kim SH, Huh J, Song J, Kang I. Spontaneous pneumomediastinum: a rare disease associated with  chest pain in adolescents. Yonsei Med J. 2015;56(5):1437-42. doi: 10.3349/ymj.2015.56.5.1437. [PubMed: 26256992].
  6. Newcomb AE, Clarke CP.  Spontaneous  pneumomediastinum: a benign curiosity or a significant problem? Chest. 2005; 128(5):3298-302. doi: 10.1378/chest.128.5.3298. [PubMed: 16304275].
  7. Dirweesh A, Alvarez C, Khan M, Christmas D. Spontaneous pneumomediastinum in a healthy young female: a case report and literature review. Respir Med Case Rep. 2017;20:129-32. doi: 10.1016/j.rmcr.2017.01.014. [PubMed: 28217437].
  8. Macia  I, Moya J, Ramos  R,  Morera R, Escobar I,  Saumench J,  et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg. 2007;31(6):1110-4. doi: 10.1016/j.ejcts. 2007.03.008. [PubMed: 17420139].
  9. Kira K, Inokuchi R, Maehara H, Tagami S. Spontaneous pneumomediastinum. BMJ Case Rep. 2016;2016:bcr2015213550. doi: 10.1136/bcr-2015-213550. [PubMed: 26786530].
  10. Song IH, Lee SY, Lee SJ, Choi WS. Diagnosis and treatment of spontaneous pneumomediastinum: experience at a single institution for 10 years. Gen Thorac Cardiovasc Surg. 2017; 65(5):280-4. doi: 10.1007/s11748-017-0755-3. [PubMed: 28283793].
  11.  Ebina M, Inoue A, Takaba A, Ariyoshi K. Management of spontaneous pneumomediastinum: Are hospitalization and prophylactic antibiotics needed? Am J Emerg Med. 2017; 35(8):1150-3. doi: 10.1016/j.ajem.2017.03.017. [PubMed: 28330688].
  12.  Dionísio P, Martins L, Moreira S, Manique A, Macedo R, Caeiro F, et al. Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years. J Bras Pneumol. 2017;43(2):101-5. doi: 10.1590/S1806-37562016000000052. [PubMed: 28538776].
  13. Bolvardi E, Pishbin E, Ebrahimi M, Mahmoudi Gharaee A, Bagherian F. Spontaneous pneumomediastinum with a rare presentation. Case Rep Emerg Med. 2014;2014:451407. doi: 10.1155/2014/451407. [PubMed: 24963422].
  14. Hogan F, McCullough C, Rahman A. Spontaneous pneumomediastinum: an  important  differential  in  acute chest pain. BMJ Case Rep. 2014;2014:bcr2014207692. doi: 10.1136/bcr-2014-207692. [PubMed: 25432910].