Daniel Henrique Gonçalves Zorato1, Sofia Fernandes2.
1Pediatric Emergency Department, Hospital Privado de Alfena, Alfena, Valongo, Portugal,
2Department of Pediatrics, Hospital Privado de Alfena, Alfena, Valongo, Portugal.
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Abstract
Spontaneous pneumomediastinum is an uncommon and generally benign condition that disproportionately affects adolescent males.1,2 It may present in isolation or alongside spontaneous pneumothorax, and its hallmark symptom is acute chest pain that brings patients to the emergency department.3 The condition is easily mistaken for a more serious cardiopulmonary pathology, which makes early recognition genuinely important.4
We describe the case of a 14-year-old boy whose parents brought him to the emergency department after he developed sudden severe anterior chest pain while at rest, with no preceding trauma or respiratory illness. Examination was unremarkable. The chest radiograph, ordered more to rule out cardiac or pulmonary causes than out of specific suspicion, unexpectedly revealed paratracheal air lucencies consistent with spontaneous pneumomediastinum and a small left apical pneumothorax. Computed tomography at a tertiary referral center confirmed the diagnosis. The patient was managed conservatively with supplemental oxygen and close observation, without the need for drainage, and recovered fully.
Spontaneous pneumomediastinum is likely more common than reported, as its symptoms are often nonspecific and the diagnosis is not always considered.1,2 Chest radiography is the appropriate first step and can be diagnostic1,2, with conservative management yielding excellent outcomes in the great majority of cases.2,3 This case illustrates how pneumomediastinum can present without any of the typical precipitating factors and why it deserves a place in the differential diagnosis of chest pain in adolescents.
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