Spontaneous pneumomediastinum and pneumopericardium in a child with severe diabetic ketoacidosis: A case report

Abstract

Apart from being the most common endocrine emergency in the pediatric intensive care unit, some clinical manifestations of diabetic ketoacidosis such as vomiting and continued acidotic breathing may, on the rare occasion, lead to unexpected complications such as pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. The differentials for the same include Hamman's syndrome secondary to forceful coughing or Valsalva maneuver, Boerhaave syndrome resulting from forceful vomiting, and even spontaneous air leaks due to severe swings in intrathoracic pressure during Kussmaul breathing, leading to alveolar rupture causing air leak. These complications may have subtle signs as well as a significant overlap in presentation and require a high index of suspicion to diagnose and careful evaluation to differentiate. We hereby report a 3-year-old child with new-onset type 1 diabetes mellitus in severe DKA, leading to pneumomediastinum and pneumopericardium where computed tomography of the thorax helped rule out differentials and the air leak resolved spontaneously with the resolution of acidosis.