(P84) A Young Man with Upper Chest Pain and Sore Throat

Chief Complaint : intermittent sore throat and upper chest pain for 3 days

History of Present Illness : A 17-year-old man presented to the emergency room with intermittent sore throat and upper chest pain for 3 days after jogging for 1.6 km. The pain was not associated with position nor exertion. The patient also denied the related symptoms like fever, dyspnea, cold sweating, nor back pain.

Pertinent Physical Exam: On physical exam, he was conscious and afebrile with a pulse rate of 96 beats/min, respiratory rate of 18 times/min, body temperature of 36.1 Celsius, and blood pressure of 119/75 mmHg. Clear breathing sound and symmetrical breathing pattern were noted.

Pertinent Laboratory Data:

Case Discussion: Pneumomediastinum is the term which defines the presence of air in the mediastinum. It usually occurs in young patients.(1) The presenting symptom is acute onset chest pain, usually retrosternal, radiating to the neck or the back.(2.3) Other frequent symptoms include dyspnea (75%), coughing spells (80%), neck pain (36%), emesis or dysphagia.(3.4) The diagnosis is based on Chest X-ray and computed tomography. After the diagnostic approach has excluded significant pathology, the pneumomediastinum treatment is directed towards symptom relief.(5) Overall, pneumomediastinum usually has good prognosis and few recurrence cases have been reported.

References and Acknowledgements (Optional): 1. Kobashi Y, Okimoto N, Matsushima T, et al.Comparative study of mediastinal emphysema as determined by etiology. Intern Med2002;41:277-82.
2. Agut A, Talavera J, Buendia A, et al.Imaging diagnosis-spontaneous pneumomediastinum secondary to primary pulmonary pathology in a dalmatian dog. Vet Radiol Ultrasound 2014. [Epub ahead of print]
3. Macia I, Moya J, Ramos R, et al.Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg 2007;31:1110-4.
4. Caceres M, Ali SZ, Braud R, et al.Spontaneous pneumomediastinum: a comparative study and review of the literature. Ann Thorac Surg2008;86:962-6.
5. Koullias GJ, Korkolis DP, Wang XJ, et al.Current assessment and management of spontaneous pneumomediastinum: experience in 24 adult patients. Eur J Cardiothorac Surg2004;25:852-5.