Spontaneous pneumomediastinum

Abstract

A young, previously well primigravida presented a few hours after a short labour with sudden onset chest pain, shortness of breath and odynophagia. She had subcutaneous emphysema but did not have significant cardiorespiratory compromise. She was found to have a spontaneous pneumomediastinum, likely secondary to raised intrathoracic pressure during labour. Similar cases have been reported previously, however there are often risk factors associated such as pre-existing lung disease and illicit drug use for which this patient did not have a significant history. The patient made a speedy recovery without requiring invasive management, as is the case for most patients documented in the literature. Consideration should be given to subsequent labours for this patient to minimise excessive intrathoracic pressure, however recurrence is rarely documented. This case is useful for healthcare professionals in assessing patients with chest pain as a reminder that unusual presentations can be diagnosed through thorough history and examination.

Figure 1

(A) Chest x-ray with mild signs of pneumomediastinum as shown by arrows. (B, C) Chest CT scan clearly demonstrating air within the superior mediastinum. No abnormalities were identified in the lung fields.