A 13-Year-Old Boy With Complications After Pneumomediastinum

Daniel Beardmore, DO; Sonika Loona, MD; Mia Mallon, MD

Disclosures

December 12, 2017

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 13-year-old athletic boy with no past medical history is transferred from a nearby suburban emergency department (ED) to an urban children's hospital for inpatient management of pneumomediastinum. On the day before transfer, he was physically active, participating in a track meet and then soccer practice immediately afterward. After the track meet finished, he began to have some mild chest pain, which increased during his soccer practice. During this second activity, he did not have to stop because of the pain but noted progressively worsening pain during "deep breathing." The night before presentation, he had increasing pain in his chest, making sleep difficult.

He describes the pain as dull, located in the substernal region, extending into his neck, aggravated by deep breaths, and alleviated with rest. He does not have any dyspnea, wheezing, palpitations, dizziness, headache, sweating, or abdominal pain. He describes a mild, intermittent dry cough, which has mostly dissipated since resolution of an upper respiratory infection about 3 weeks ago.

The patient lives at home with his immediate family in a suburban area. His social history includes no smoke exposure or significant travel history, and his immunizations, including an annual influenza vaccination, are up to date. Family medical history is noncontributory and includes no history of asthma, heart disease, blood clots, or sudden/early death.

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