A review of non-obstetric spontaneous pneumo-mediastinum and subcutaneous emphysema

A man in his early twenties was admitted from the streets. He was hallucinating and incoherent. His vital signs were normal and there was no sign of injury. There was subcutaneous emphysema over the neck and anterior chest. The breath sounds were good and the heart sounds were audible. Chest X-ray showed extensive subcutaneous emphysema extending into the neck, but no pneumomediastinum or pneumothorax. A Hexabrix swallow demonstrated no leak. A computed tomography (CT) scan showed extensive surgical emphysema but no underlying pathology. Over the following 48 hours he was treated with a 40% oxygen mask. He remained stable and the surgical emphysema settled completely. Urine testing for cannabis and cocaine were negative. He was certified and admitted to a closed psychiatric ward. No further surgical problems occurred during the following month.