Een spontaan pneumomediastinum bij een fitnessbeoefenaar: casusbespreking

Spontaneous pneumomediastinum in a fitness enthusiast: a case report Case: An 18-year-old young man presents with sudden pain in the neck and recent onset hoarseness. The patient reports a palpable subcutaneous sensation in the shoulders and neck region. He recently started fitness training (weightlifting). Clinical examination reveals a mild tachycardia and bilateral subcutaneous emphysema in the thoracic region. No other significant findings are noted. A chest CT-scan reveals significant pneumomediastinum and pneumopericardium accompanied by subcutaneous emphysema in the cervical base, prepectoral, and axillary regions. The patient is admitted for 24-hour observation after which he was discharged from the hospital. Discussion: Spontaneous pneumomediastinum (SPM) is a rare condition characterized by free air in the mediastinum. This can occur due to a sudden increase in intrathoracic pressure, which causes alveolar rupture, allowing air to enter the interstitial space. Potential complications include pneumopericardium, tension pneumothorax, pneumoperitoneum, and pneumorrhachis. Symptoms may include dyspnoea, chest pain, neck pain, cough, odynophagia, and dysphagia. A clinical examination may reveal subcutaneous emphysema and crepitus with each heartbeat. Nevertheless, 30% of patients with uncomplicated SPM are asymptomatic, necessitating the use of imaging studies for diagnosis. While chest X-ray is the gold standard, CT-scans may be useful to exclude other diagnoses. Conservative therapy is usually sufficient (symptomatic management), although any potential complication should be identified and treated appropriately. Conclusion: SPM is a rare condition primarily encountered by emergency physicians, but also by general practitioners and sports physicians. While it may not be the most likely diagnosis for thoracic pain, it should be considered in the differential diagnosis. Once complications are ruled out, conservative treatment can be pursued.