Spontaneus Pneumomediastinum in a Pediatric Patient

Background: Spontaneous pneumomediastinum is the presence of air in the mediastinum in the absence of traumatic or iatrogenic causes. It is rare in pediatric age and several precipitating factors are described. It is usually benign and self-limited, and treatment is supportive.

Case Report: A 17-year-old male, with a previous right spontaneous pneumothorax submitted to thoracentesis 14 months before, immunizations updated, presented to our emergency department with sudden suprasternal thoracic pain throughout a handball training, which worsened with inspiration and cervical mobilization, in the last 24 hours. He also had an history of odynophagia and sporadic coughing and an upper respiratory infection two weeks ago. He denied fever, trauma, medications or drug use. He was hemodynamically stable, oxygen saturation 100%. His weight was 55 kg (10th centile) and height 170 cm (15-50th centile). On physical examination he had suprasternal subcutaneous crepitations and tonsilar erythema. The chest radiograph revealed linear air leaks along the mediastinal borders, without pneumothorax, and the lateral radiograph showed paratracheal air and suprasternal subcutaneous emphysema. Pharingeal Group A Streptococcus test and C-reactive protein were negative and blood count was normal. IgM antibody Mycoplasma pneumoniae was positive. He presented sinus bradycardia in the electrocardiogram. Treatment included supplemental oxygen and azithromycin 10 mg/kg/day for five days. He had no need of analgesia. At the second day of hospitalization he was asymptomatic. The chest and lateral radiograph 4 days after admission showed almost complete resolution of the pneumomediastinum and subcutaneous emphysema. IgM antibody Mycoplasma pneumoniae remained positive one month after episode.

Discussion: In this case, physical activity, Mycoplasma pneumoniae infection with cough and longilineus habit could be the triggering factors. The autors pretend to alert to the occurrence of this pathology with nonspecific symptoms, requiring a high level of suspicion for a correct diagnosis.