A Crunch That Spoke: An Atypical Presentation of Spontaneous Pneumomediastinum in an Elderly Male

Spontaneous pneumomediastinum is a rare, usually self-limiting, condition characterized by the presence of free air in the mediastinal cavity without any identifiable precipitating factor. We report the case of a 63-year-old man who presented with chest pain, chest tightness, and shortness of breath. The patient had no known comorbidities and no history of smoking or alcohol intake. On examination, the patient was found to have subcutaneous emphysema around the neck and chest progressing to the face and upper limbs and extending to the groin, with no external injuries. Crepitus was present, extending from the face to the abdomen, and Hamman’s crunch was noted. Chest imaging revealed free air within the mediastinum, confirming the diagnosis of spontaneous pneumomediastinum. The patient was treated with high-flow oxygen via a non-rebreather mask, and the respiratory condition was closely monitored. A left-sided intercostal drainage tube was placed due to extensive subcutaneous emphysema. The patient gradually showed clinical improvement and was discharged following the resolution of pneumomediastinum.