An Uncommon Cause of Spontaneous Pneumomediastinum and Subcutaneous Emphysema

Edwards, Michael; Ramappa, Arun Jeenahalli

A 79-year-old gentleman presented with spontaneous pneumomediastinum and subcutaneous emphysema with pneumonia but no pre-existing lung disease. He presented with a 4-day history of increased shortness of breath, pleuritic chest pain, fevers, and non-productive cough. After 4 days of intravenous antibiotics, the patient developed considerable subcutaneous emphysema and pneumomediastinum. Pneumomediastinum presents most commonly with chest pain, shortness of breath, and subcutaneous emphysema. It has previously been associated with cases of pneumonia but often with rare strains such as P. jirovecii pneumonia in immunocompromised patients. This case highlights spontaneous pneumomediastinum as a rare complication of pneumonia. Treatment of pneumomediastinum is typically conservative, and although options may be limited, aggressive management of any causative factor may be essential in selected cases. LEARNING POINTS: Pneumomediastinum and subcutaneous emphysema are rare complications of pneumonia. Computerised tomography is a valuable diagnostic tool for identifying pneumomediastinum in patients with subcutaneous emphysema. While pneumomediastinum is typically a benign condition, aggressive management may occasionally be required. Evidence regarding use of non-invasive/invasive ventilation remains limited but it may theoretically aggravate any air leakage.