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

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


March 01, 2022

The patient in this case was unique because he did not have a history of the known risk factor, asthma. The case was also unusual because the patient's pneumomediastinum developed as a result of excessive physical exertion during sports activity, another recognized but less common cause of pneumomediastinum. This activity probably resulted in an alveolar rupture and air tracking back to the chest and beyond.

The patient's presentation was clinically similar to that of most pneumomediastinum cases, in that he improved quickly after being admitted; this is the usual scenario when the initial insult has ceased. Again, his case was unusual because the insult that resolved was exertion and not bronchospasm or cough, as is most common.

Suspicion for this condition should be high when the presentation is preceded by the Valsalva maneuver, forceful coughing or vomiting, hyperpnea, bronchial asthma, inhalation of drugs, foreign body aspiration, childbirth, or intense physical exertion. His hospitalization was average compared with other patients with a similar condition, in that he spent 1 day in the hospital.[2]

Furthermore, this case was unusual owing to the finding of pneumorrhachis, which is quite rare. In the author's review of the literature, a study from the Journal of Trauma identified only 50 cases of pneumorrhachis in 42 total studies.[3] This finding further demonstrates that pneumorrhachis is a rare phenomenon that is specifically seen after spontaneous pneumothorax. These rare nontraumatic case reports of pneumorrhachis typically include histories of significant cough.[4] The patient in this case reported only a lingering, nearly resolved, and mild intermittent cough that was not worsened during his prolonged physical activity. In addition, no cough was observed during his hospital stay. Although some case reports in the literature describe pneumorrhachis with significant signs and symptoms, including cervical myelopathy, paraplegia, and mild headache, these findings were in adults.[5,6] The patient in this case had none of those signs or symptoms.


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