Spontaneous pneumomediastinum mimicking angioedema in an asthmatic teenager

Spontaneous pneumomediastinum [SPM] often presents with chest pain, cough, and/or dyspnea. The presentation with facial swelling is less frequently mentioned and may be misinterpreted as angioedema. A palpable subcutaneous crepitus, an audible mediastinal crunch, and subcutaneous or mediastinal air in chest X-ray should be carefully sought. We present a boy with an asthma exacerbation and bronchopneumonia who developed facial swelling following an antibiotic injection. Careful scrutiny of the Chest X-ray for an evidence of subcutaneous air would have negated an initial thinking of angioedema. SPM should be included in the differential diagnosis of acute swelling of the face during asthma exacerbations