Presentation
Increasing chest pain for 3 weeks.
Patient Data
Longitudinal radiolucent streaks in the mediastinum.
Thin radiolucent line seprating the visceral and parietal pericardium.
Subcutaneous emphysema is seen in both supraclavicular and neck regions.
Axial mediastinal and lung window CT scans confirmed the previously mentioned x-ray findings; extensive pneumomediastinum from the upper cervical region and reaching the diaphragm, and subcutaneous emphysema in both cervical and clavicular region.
The trachea and bronchi are patent. Both lungs are clear. No pneumothorax. The heart size is normal. The great vessels are unremarkable. There is no evidence of lung masses, consolidation or ILD. No pericardial or pleural effusion. No mediastinal or axillary enlarged lymph nodes. Both adrenals are unremarkable.
Case Discussion
Pneumomediastinum is identified as the presence of air within the mediastinal spaces. Various etiologies are responsible for pneumomediastinum, including intrathoracic or extrathoracic and traumatic or nontraumatic etiologies.
Comprehensive history taking and clinical examination should exclude any secondary causes of pneumomediastinum, such as; pneumothorax, recurrent vomiting, rupture of air bulla, air trapping in asthmatic patients, or any traumatic or iatrogenic causes.
This patient presents with a 3-week history of chest pain that aggravated in the last two days. Physical examination reveals crepitations in the neck region. The patient denies any medical illness, surgical intervention, or traumatic event.
On further questioning, the patient revealed that the pain started after he had played at the gym (lifting weights) 3 weeks earlier. After excluding any other secondary etiology by radiological and clinical examinations, this lifting us with lifting weights as the prober cause for his presentation.
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