Rare Case of Pneumomediastinum with Pneumopericardium and Subcutaneous Emphysema

Pneumomediastinum, which refers to the presence of air in the mediastinum, typically occurs in association with an underlying lung disease.Pneumopericardium is presence of air or gas in the pericardial cavity.Pneumopericardium most commonly results from trauma (in approximately 60% of the reports).A thin built 17-year male without any previous history of chronic illness presented with complaints of throat pain, fever, cough with expectorant (white), decreased appetite, shortness of breath, retrosternal chest pain on inspiration and weight loss.On cardiac auscultation, crunching sound synchronous with heartbeat was audible (Hamman's crunch sign).Chest X-ray was suggestive of pneumomediastinum, pneumopericardium and subcutaneous emphysema.Patient was started on IV and oral antibiotics, antitubercular medication, and oxygen support with nonrebreather oxygen mask.At the time of discharge, his cough, chest pain and shortness of breath had subsided, his appetite had improved, he had gained 3 kg body weight, and repeat CXR showed significant resolution of pneumopericardium.