A Rare Case of Spontaneous Pneumomediastinum and Pneumopericardium in a 21-Year-Old Male

Spontaneous pneumomediastinum and pneumopericardium, two rare conditions, are mainly described in patients with underlying respiratory illnesses. We present the case of a healthy 21-year-old male who developed these conditions abruptly after a single episode of coughing. Possibly, it was provoked by an increase in intra-alveolar pressure which caused alveolar rupture and air dissemination along the bronchovascular sheath and into the pericardial sac via vulnerable areas. These events led to sustained symptomatology, which prompted the patient to seek medical referral. The presence of air within the mediastinum and pericardium was associated with characteristic auscultatory findings, known as "Hamman's sign," and echocardiographic findings, referred to as the "air gap sign." The condition was diagnosed using a thoracic X-ray, which demonstrated a distinct dark line extending from the level of the left pulmonary artery along the left cardiac contour, curving around its border, a finding consistent with free air in the mediastinum and pericardium. This was subsequently confirmed by thoracic computed tomography. The condition was self-limiting. The patient quickly became asymptomatic, and his vital signs remained normal. No complications or hemodynamic compromise occurred, and he did not require any special medical treatment other than adequate oxygenation. After close monitoring via telemetry and blood examinations, discharge was decided on the third day, following a repeat X-ray, which revealed complete resolution. A follow-up chest radiograph and transthoracic echocardiogram performed two weeks later showed no pathological findings.