Spontaneous pneumomediastinum and subcutaneous emphysema in asthma exacerbation: an unusual presentation

ABSTRACT

Pneumomediastinum is defi ned as presence of air in mediastinum. Spontaneous pneumomediastinum [SPM] incidence ranges from 1800 to 142000. It is more common in the young, tall males. Here we present a female aged 22 years, who presented to the casualty with sudden onset of breathlessness followed by pain around the neck and chest associated with dysphagia. She was a known asthmatic since several years on regular treatment. Respiratory system examination revealed bilateral polyphonic rhonchi. Chest radiograph revealed features of subcutaneous emphysema and pneumomediastinum. Computed tomography of the thorax confi rmed the fi ndings. She was diagnosed to have an exacerbation of bronchial asthma complicated by pneumomediastinum, probably due to alveolar rupture. She was managed with oxygen, bronchodilators, steroids and other supportive measures following which she improved. This case is being presented to emphasize the possibility of SPM as a rare complication of asthma exacerbation, showing good response to conservative management