Young man with Spontaneous Pneumomediastinum with Atypical Presentation

Abstract

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.