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Case Reports
. 2016 Dec 15;6(6):33361.
doi: 10.3402/jchimp.v6.33361. eCollection 2016.

Spontaneous pneumomediastinum, pneumoretroperitoneum, and cervicofacial subcutaneous emphysema after repeatedly and forcefully blowing into a bottle

Thein Swe  1 , Akari Thein Naing  2 , Antony Lixon  3 , Joseph Quist  3
Affiliations
Case Reports

Spontaneous pneumomediastinum, pneumoretroperitoneum, and cervicofacial subcutaneous emphysema after repeatedly and forcefully blowing into a bottle

Thein Swe et al. J Community Hosp Intern Med Perspect. .

Abstract

Spontaneous pneumomediastinum (SPM) is an uncommon, self-limiting condition associated with increased intra-thoracic pressure resulting in alveolar rupture. Search of the literature revealed no detailed case report about a 26-year-old psychiatric patient who repeatedly and forcefully blew air into a bottle for 5 days resulting in a combined condition of spontaneous pneumoretroperitoneum, pneumomediastinum, and cervicofacial subcutaneous emphysema. It is crucial to find a primary source and treat appropriately. Psychiatric patients may have psychotic behaviors mimicking Valsalva's maneuver that increases intra-thoracic pressure and causing SPM. Optimal medications should be given to control psychotic behaviors. Family members and caregivers should be explained about this unusual behavior so that they can prevent this rare condition.

Keywords: blowing bottle; pneumomediastinum; pneumoretroperitoneum; subcutaneous emphysema; valsalva maneuver.

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Conflict of interest statement

and funding The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

Figures

Fig. 1
Fig. 1
Anteroposterior (AP) view of chest X-ray showing extensive subcutaneous emphysema in the chest and neck.
Fig. 2
Fig. 2
Axial view of CT chest revealing cervical and facial subcutaneous emphysema.
Fig. 3
Fig. 3
Axial view of CT chest revealing extensive pneumomediastinum and subcutaneous emphysema.
Fig. 4
Fig. 4
Coronal view of CT chest, abdomen, and pelvis revealing pneumomediastinum and subcutaneous emphysema from neck area to left flank of abdomen.
Fig. 5
Fig. 5
Axial view of CT abdomen showing punctate retroperitoneal air around left kidney.
See this image and copyright information in PMC

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