Spontaneous Cervical Subcutaneous Emphysema and Pneumomediastinum

Abstract

Subcutaneous emphysema of the head and neck with pneumomediastinum is classified into two categories: spontaneous and nonspontaneous. Spontaneous subcutaneous emphysema with pneumomediastinum has been defined as the presence of interstitial air in the subcutaneous tissue or the mediastinum without any apparent trauma or iatrogenic injury. The disease is rare, typically affects young adults, often results from predisposing factors (e.g., asthma, chronic obstructive pulmonary disease (COPD), airway infection, or smoking), and is induced by recent precipitating factors (e.g., fierce vomiting, coughing, or intense physical exertion). We describe a 20-year-old woman who experienced pain in her lower neck and anterior chest after she choked when drinking soy milk. Radiological studies revealed a subcutaneous emphysema in the neck, extending from the retropharyngeal space to the mediastinum. The patient recovered after 3 days of conservative therapy. Subcutaneous emphysema is a benign entity that seldom results in catastrophic events, and therefore requires only conservative management, as in the present case.