Young woman with dyspnea and neck swelling

A healthy 19-year-old woman presented to the emergency department with a 7-day history of dyspnea and a 1-day history of neck swelling. She reported regular participation in boxing and receiving sports massage. Physical examination revealed bilateral neck swelling with crepitus. The emergency physician performed a neck soft tissue radiograph (Figure 1) and confirmed the diagnosis by a chest computed tomography (Figures 2 and 3).

Spontaneous pneumomediastinum, also referred to as Hamman's syndrome,¹ is characterized by the presence of air in the mediastinum without an apparent etiology. This condition arises from alveolar rupture and commonly resolves spontaneously.² Patients presenting with spontaneous pneumomediastinum and no absent additional complications, such as vomiting, typically undergo a brief period of observation and receive symptomatic care.³ Surgical interventions may be warranted for individuals exhibiting clear evidence of mediastinal organ injury.⁴ Although spontaneous pneumomediastinum is mainly treated with observation, delayed diagnosis may lead to fatal complications, such as infection or tension pneumothorax.⁵

No identifiable perforation site was noted during the esophagogastroduodenoscopy of our patient. The patient underwent conservative management, and subsequent radiography after 1 week indicated resolution of the pneumomediastinum. She was discharged without any adverse outcomes.

The authors have no conflicts of interest to report.

The authors have no professional or financial affiliations.