Spontaneous pneumomediastinum with cervical emphysema: Rare differential diagnosis of acute sore throat and dysphagia

Introduction:

The Spontaneous pneumomediastinum (SPM) is a rare differential diagnosis with spontaneous improvement in the course of disease, but potentially serious complications. Mostly young adults are affected. The clinical picture is characterized by non-specific symptoms such as neck and chest pain, odynophagia and dyspnea. Pathognomonic is the crackling sound palpable in cutaneous emphysema.

Methods:

A 19-year-old patient was suffering from odynophagia for 2 days and developed a crackling soft tissue swelling palpabel on the right neck, throut tightness and thoracic pain over night. No cough, no fever, no infection.

Results:

First, internist presentation and exclusion of a pneumothorax by X-ray thorax. Because of persistent symptoms on the following day, CT of the neck was performed, revealing a pronounced soft tissue emphysema prevertebral and in the in the vascular compartment of the neck on both sides, reaching into the mediastinum. In panendo- and bronchoscopy, there was no evidence of perforation as the cause of emphysema. For prophylaxis of infection intravenous administration of a cephalosporin. Because of declining symptoms the patient was discharged after 5 days

Conclusions:

The SPM with cervical emphysema as a cause of acute sore throat and dysphagia is rare, but should be considered as a differential diagnosis, due to potential complications such as extraperikardial cardiac tamponade, mediastinitis and tension pneumothorax. Sports, drug abuse and asthma among others are discussed as triggers. After the exclusion of potential causes, inpatient monitoring and symptomatic therapy by analgesia are carried out. The need for antibiotic treatment as prophylaxis of infection is discussed in the literature.

Publication History

Publication Date:
23 April 2019 (online)