Pneumomediastinum after retching

Abstract

A 25-year-old woman with hirsutism presented to the Emergency Department of the medicine faculty in Gaziantep University with a 4-h History of dyspnoea, dysphagia, coughing, continuous and progressive chest pain radiating to the back and palpation of her neck. The physical examination was significant for diffuse neck and chest subcutaneous emphysema. The x-ray study and CT scan of the chest revealed pneumomediastinum. The patient reported that 6 h before presentation she took spironolactone due to hirsutism and she retched. Retching caused the symptoms. The patient was followed conservatively and fully recovered over the next 7 days. Spontaneous pneumomediastinum developed in this patient with no underlying lung disease, presumably from air leakage secondary to the excessive elevation of intrathoracic pressure due to retching. Pneumomediastinum is an uncommon disease arising most frequently and remains largely underdiagnosed clinically, especially in young, healthy patients.

Figure 1

Chest x-ray on admission showed mediastinum emphysema, with air extending to the tissue of the neck.

Figure 2

Chest CT revealed marked air accumulation around the aorta, trachea, and pericardium. Deep cervical emphysema was also observed.

Figure 3

Cervical emphysema was also observed in lateral cervical x-ray.