Background:

Spontaneous pneumomediastinum is a rare entity that most commonly affects young males between 18 and 25 years of age.

Case report:

Twenty-year-old male, with a history of smoking since he was 16. He presented with retrosternal, transfictive pain, irradiated to the interscapular region, which increased with inspiration, secondary to a cough access. Physical examination: height 1.85 m; weight 87 kg; BMI 25.42; HR 85 beats/min; RR 18/min; BP 120/80; Temp. 36.6 oC; normal neck; chest: rhythmic cardiac sounds accompanied by a rough crunching sound synchronous with the heartbeat, pulmonary fields with a normal vesicular murmur; normal electrocardiogram and undetectable serial cardiac troponin. The chest CT scan showed the presence of air in the mediastinum extending caudally to the descending aorta and supra-aortic vessels. With the diagnosis of spontaneous pneumomediastinum, he was managed with rest, analgesics and oxygen, 3 liters/min for 72 hours. He was discharged asymptomatic.

Conclusions:

Spontaneous pneumomediastinum is generally benign and self-limited; it affects children and young adults; triggers include asthma, respiratory tract infections, vigorous vomiting or coughing, intense physical effort, or Valsalva maneuver.