Teenager with chest pain and swollen neck: a leave-it-alone condition

Thorax
Pen-Yuan Liao, Hung-Jung Wang

Abstract

A 19-year-old boy with shortness of breath and chest pain after strenuous exercise presented to emergency department . On physical examination, the neck and shoulders appeared to be swollen. There was crepitus on skin palpation. Chest X-ray disclosed diffuse subcutaneous emphysema and pneumomediastinum. CT showed additional finding of air in epidural space. The patient was discharged after 2 days of hospitalisation with conservative treatment uneventfully. Pneumorrhachis is usually caused by abrupt increase in intrathoracic pressure in instance of forceful vomiting, cough or asthma attack in an otherwise healthy young adult. It is usually accompanied with pneumomediastinum. The management of epidural pneumatosis should be tailored according to its primary cause. For most patients with pneumorrhachis associated to a spontaneous pneumomediastinum without neurological symptoms, this condition is generally self-limited. For epidural free air of large volume that causes neurological deficits, surgical laminectomy may be indicated.

References

Nov 30, 2007·Pediatrics International : Official Journal of the Japan Pediatric Society·Tatsuo KonoIchiro Seki
Apr 1, 2008·The Spine Journal : Official Journal of the North American Spine Society·Kyung-Jin Song, Kwang-Bok Lee
Nov 29, 2014·World Journal of Radiology·Sadayuki Murayama, Shinji Gibo

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Citations

Feb 16, 2019·BMJ Case Reports·Anoopkishore Chidambaram, Sirisha Donekal

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