Successful Conservative Approach of Managing Spontaneous Pneumomediastinum in a Young Female: A Case Report and Literature Review

Spontaneous pneumomediastinum (SPM) is defined as gas in the mediastinum in the absence of structural damage to the aerodigestive tract. It occurs secondary to the Macklin phenomenon, which is alveolar rupture due to hyperdistension. Although it has a benign nature, most patients get admitted to the hospital and undergo unnecessary investigations. A 20-year-old female presented to the emergency department with retrosternal chest pain. She had no preceding history of vomiting or alcohol intake. She was diagnosed with celiac disease by endoscopic biopsy eight months ago. The patient was vitally stable. Chest examination was unremarkable. Basic labs revealed no elevation in inflammatory markers. Chest X-ray revealed pneumomediastinum. A pulmonologist was consulted and advised for computed tomography (CT) thorax with contrast, which confirmed the presence of pneumomediastinum with no associated subcutaneous emphysema or pleural effusion. The patient was discharged home with close follow-up in the pulmonology clinic. No antibiotics or further esophageal evaluation were performed. Her final diagnosis was SPM, and she continued to do well on further visits. Although endoscopy is a well-known cause of both SPM due to simple reflexes to scope manoeuvres like cough reflex, and secondary complex pneumomediastinum due to esophageal perforation, the patient's benign course is more in favour of SPM. An early pulmonology consultation resulted in the safe discharge of the patient, preventing unnecessary admission and investigations. This highlights the benign nature of the condition and the potential cost savings associated with prompt diagnosis and treatment.