Spontaneous subcutaneous emphysema and pneumomediastinum in a child with bronchial asthma

Massive spontaneous subcutaneous emphysema is rare in the absence of trauma. An 11-year-old male child, a known case of poorly controlled bronchial asthma presented with sudden onset of respiratory distress after a sudden bout of cough. He also had painful swelling of the neck, chest, abdomen, and upper limbs. On clinical and radiological examination, he was found to have massive subcutaneous emphysema. A gastrografin study was done which showed no esophageal perforation. Computed tomography of his neck and thorax demonstrated pneumomediastinum with no lung or pleural pathology. Management was conservative with supplemental oxygen, nebulized bronchodilators, corticosteroids, and intravenous antibiotics. Child improved symptomatically without any surgical intervention and was discharged after 7 days.