Spontaneous Pneumomediastinum in a 15-Year-Old Adolescent After Unintended Overexposure to Paint Diluent (Thinner) Fumes: First Reported Case

Abstract

Spontaneous pneumomediastinum (SPM) is the presence of air in the mediastinal interstices in the absence of any surgical or medical procedure, chest trauma, or mechanical ventilation. SPM can occur during vigorous Valsalva maneuvers, such as weight lifting, coughing fits, hyperemesis gravidarum, and so on, or during inhalation of illicit substances or toxic agents, as a result of an abrupt increase in pressure in the tracheal tree. Preexisting underlying lung disease may be a contributing factor. In the present case, we report for the first time an SPM due to accidental overexposure to paint thinner in a 15-year-old male from a low-income rural family. He was offered a job painting the inside of a house, which he accepted to earn some money for the family household. However, due to his inexperience, he overdosed on a can of paint with thinner. About 2 h after starting work, he began to feel increasingly severe chest pain and had to be rushed to the local level one basic hospital by his parents. Physical examination revealed subcutaneous emphysema over the supraclavicular area and crackles in the precordial area. Chest radiographs showed a pneumomediastinum. In retrospect, the patient denied coughing or sneezing attacks after exposure. He was transferred to a regional tertiary hospital for further diagnostic evaluation to rule out airway/esophageal perforation. Chest computed tomography confirmed underlying SPM and subcutaneous emphysema. The oesophagogram and bronchoscopy were unremarkable. SPM, possibly secondary to overexposure to thinner vapors, a hydrocarbon-based compound, was the final diagnosis. The patient was discharged asymptomatic on day 5.

Keywords: Pneumomediastinum; case report; chest pain; hydrocarbons; inhalation; paint diluent; subcutaneous emphysema.

Figure 1.

Patient chest radiograph showing pneumomediastinum (dotted black arrow) with pneumopericardium (solid black arrows) and subcutaneous emphysema in the right supraclavicular fossa (white arrow).

Figure 2.

Chest computed tomography (CT). (A) Axial section at the level of the sternal manubrium showing subcutaneous emphysema in the left supraclavicular fossa (arrow). (B) Axial section corroborating the presence of air in the mediastinum (dotted white arrow). (C) Sagittal view showing the extent of subcutaneous emphysema.