Cervico-Mediastinal Emphysema Due to Panic Attack: A Case Report

Spontaneous cervical emphysema is an uncommon entity characterised by free air in the deep neck spaces without obvious cause. The differential diagnosis of cervical emphysema is broad, because the visceral space is contiguous with mediastinum and retroperitoneum. We present an unusual case of spontaneous cervico-mediastinal emphysema (CME) that occurred in an 18-year-old female after a panic attack. The presenting features included dyspnoea, chest pain and subcutaneous emphysema. She had no other sign of aerodigestive tract pathology, and history was negative for risk factors such as asthma, vomiting and recreational drug use. Computed tomography of the neck and thorax demonstrated retropharyngeal and visceral space emphysema extending through the mediastinum. No other abnormalities such as lung bullae were apparent, leading to a diagnosis of spontaneous CME. The patient was admitted for observation, treated with intravenous antibiotics, and made a full recovery. This case demonstrates that cervical emphysema can occur as a result of panic disorder and consequent hyperventilation. Respiratory or gastrointestinal pathology is not a prerequisite for the occurrence of CME.