CRA41 A RARE CAUSE OF CHEST PAIN: SPONTANEOUS PNEUMOMEDIASTINUM

Nurul Izzati Zakaria1, Ng Ling Fong¹, Yew Boon Teong¹, Noor Hidayah Binti Yahya¹
Internal Medicine, Hospital Enche’ Besar Hajjah Khalsom, Kluang, Johor, Malaysia

Introduction:

Spontaneous pneumomediastinum (SPM) is defined as the presence of free air in the mediastinum without a clear etiology. SPM is a rare condition, benign and usually self-limiting condition prevalent in young adults. 

Objective:

To demonstrate pneumomediastinum as an important differential diagnosis in adults with chest pain and dyspnoea.

Methodology:

We report a case of  24-years-old gentleman who was an active smoker ,underlying childhood asthma, complaining of chest pain, neck pain, dyspnea and cough for 1 day . Upon arrival to ED, noted crepitus over neck and generalized rhonchi over lungs. 

Results:

Neck X-ray was noted subcutaneous emphysema whereas Chest X-ray was noted pneumomediastinum. Oesophagogastroduodenoscopy (OGDS) revealed normal esophagus and superficial ulcer at prepyloric region Forrest III. Flexible nasopharyngolaryngoscopy and tracheobronchoscopy were done revealed normal vocal cords and no evidence of tracheal injury. Computed tomography (CT) scan of neck and thorax revealed extensive pneumomediastinum and pneumopericardium with subcutaneous emphysema of the neck, parapharyngeal and carotid spaces bilaterally. No focal collection visualized and no determine cause or site of injury was found. Case was referred to cardiothoracic team HSIJB, planned for conservative management. Patient was treated as acute exacerbation bronchial asthma secondary to pneumonia. Repeated chest and neck radiograph on day 6 of admission showed resolution of pneumomediastinum and resolving subcutaneous emphysema over neck. He was discharged well with symbicort tubuhaler and advised for smoking cessation.

Conclusion:

SPM mainly develops due to alveoli rupture after increased in intra-alveolar pressure. It is potentially life-threatening, fortunately most cases are managed conservatively. Although it is rare incidence, it should be an important differential diagnosis must be excluded among young adults with chest pain and dyspnea.