A 13-Year-Old Athlete With Chest Pain, Cough After Practice

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


March 01, 2022

Physical Examination and Workup

Upon initial physical examination at the ED, the patient was reported to be well-appearing and in no acute distress, with normal vital signs. The transport team brings with them his initial ED complete blood count and complete metabolic panel, which are both within normal limits, and an EKG that reveals a normal sinus rhythm. The ED information also includes a chest radiograph (Figure 1), which identifies extensive pneumomediastinum with subcutaneous emphysema, and air extending into his neck.

Figure 1.

CT reveals extensive pneumomediastinum (Figure 2) with associated pneumopericardium (Figure 3); air in the pleural space and subcutaneous emphysema (Figure 4); and an additional finding (Figures 5 and 6), which is the primary reason for his transfer to a children's hospital for further management.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Upon arrival, the boy is in stable condition. His vital signs are still normal, and he is in no respiratory distress. His physical examination includes palpable crepitus surrounding the proximal neck base and the thoracic inlet. No tenderness is noted in response to palpation of the chest wall, sternum, or rib cage. Cardiac auscultation demonstrates regular rate and rhythm, with no murmur. Lung auscultation is completely clear, and the remainder of his examination, including full neurologic examination, is likewise unremarkable. Test results are negative for COVID-19.


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