Chest Pain Beyond Asthma: A Case of Spontaneous Pneumomediastinum in a Young Adult with Asthma

Background: Spontaneous pneumomediastinum is an uncommon cause of chest pain and breathlessness, often seen in young adults with asthma. Its symptoms may mimic asthma exacerbations or chest infections, leading to a diagnostic delay. Case Presentation: The author reports the case of a 30-year-old man with asthma who initially presented to an out-of-hours service with cough, sputum, and shortness of breath. He was treated for a chest infection, but subsequently developed pleuritic chest pain and worsening breathlessness. On arrival at the emergency department, he was tachypnoeic with palpable neck crepitus. Chest X-ray and CT thorax confirmed pneumomediastinum, subcutaneous emphysema, and a small apical pneumothorax. Management and Outcomes: The patient was admitted under the cardiothoracic team and managed conservatively with O2, bronchodilators, and corticosteroids. A chest tube was not required as the pneumothorax was small and stable. He was discharged after 3 days, with complete radiological resolution at 2 weeks and no recurrence. Conclusion: Spontaneous pneumomediastinum should be considered in young adults with asthma presenting with acute chest pain and breathlessness. Clinical examination and imaging are essential for diagnosis, and most cases resolve with supportive treatment. Increased awareness can prevent unnecessary antibiotics or invasive interventions.