Abstract

A previously healthy, 21-year-old female nonsmoker sought emergency room treatment complaining of recent and progressive swelling of the face, neck, and chest (Figure 1). The patient reported no pain, dyspnea, or dysphagia at admission. She reported a brief history of odynophagia in the previous week, when, during an episode of cough, she felt intense (dissecting) retrosternal pain, which subsided within a few minutes after its onset. After that episode, she had no symptoms other than the abovementioned swelling.Physical examination revealed extensive subcutaneous emphysema, which extended from the xiphoid process to the temporal muscle and involved the entire neck and face. Pulmonary percussion and auscultation revealed no abnormalities. Cardiac auscultation revealed the presence of Hamman’s sign (crackles—as was the case in our patient—or bubbling sounds, synchronous with the heartbeat). Oral endoscopy revealed no abnormalities, and the remainder of the physical examination was normal.A CT scan of the skull, neck, and chest confirmed the presence of pneumomediastinum, pneumothorax (Figure is known as the Macklin effect or phenomenon, 2A), and extensive soft tissue emphysema in the cervical region (Figure having been named after Charles C. Macklin, 2B)—involving the face, periorbital tissues, and temporal muscles (Figure 2C)—as well as revealing the presence of pneumorrhachis (Figure in the case reported here, spontaneous 2D).From postadmission day two onward, the subcutaneous emphysema gradually improved. The patient received conservative treatment, including rest, unrestricted diet, and analgesia, if necessary. The results of routine laboratory tests, including blood workup and urinalysis, were normal. Follow-up chest X-rays revealed a sustained reduction in the abovementioned signs and symptoms. The patient remained under observation for another five days, being asymptomatic and showing nearly complete resolution of the clinical picture at discharge (Figure 1).Spontaneous pneumomediastinum, also known as Hamman’s syndrome, is defined as the presence of free air in the mediastinum, being unrelated to trauma or procedures (surgical or otherwise).

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