A Tenacious Trio of Retropharyngeal Emphysema, Pneumomediastinum and Subcutaneous Emphysema Secondary to Pulmonary Tuberculosis: A Case Report

Retropharyngeal emphysema (RPE) is the presence of air in the retropharyngeal area. It may occur due to various etiologies or sometimes spontaneously due to an underlying lung pathology. This report describes a case of a 26-year-old gentleman with pulmonary tuberculosis on treatment who presented with acute breathlessness and dysphagia. His neck and chest radiograph showed retropharyngeal emphysema with pneumomediastinum and subcutaneous emphysema. This was further confirmed by a CT neck and thorax. The patient was managed conservatively with analgesia, antibiotics, IV corticosteroids and oxygen supplementation. Repeat chest radiograph after 17 days showed resolution of retropharyngeal emphysema. Clinicians should have a high index of suspicion for RPE in patients who present with unexplained acute breathlessness and dysphagia of a diseased lung.