Yonsei Med J.  2014 Jan;55(1):270-272. 10.3349/ymj.2014.55.1.270.

A Case of Pneumomediastinum and Parapneumonic Effusions Following Pharyngeal Perforation Caused by Shouting

• Kim SW
• Kang HH
• Kang JY
• Kim SK
• Lee BY
• Lee SH
• Moon HS

• KMID: 1779916
• DOI: http://doi.org/10.3349/ymj.2014.55.1.270

Abstract

Spontaneous pneumomediastinum is an uncommon disorder, and usually affects young men and has a benign course. Common triggers are asthma, the smoking of illicit drugs, the Valsalva maneuver, and respiratory infections. Most cases are usually due to alveolar rupture into the pulmonary interstitium caused by excess pressure. The air dissects to the hilum along the peribronchovascular sheaths and spreads into the mediastinum. However, pneumomediastinum following pharyngeal perforation is very rare, and has only been reported in relation to dental procedures, head and neck surgery, or trauma. We report a case of pneumomediastinum that developed in a 43-year-old patient with pharyngeal perforation after shouting. His course was complicated by mediastinitis and parapneumonic effusions.

Keyword

Pneumomediastinum; pharyngeal perforation; mediastinitis; parapneumonic effusions

MeSH Terms

Adult
Humans
Male
Mediastinal Emphysema/*diagnosis
Mediastinitis/*diagnosis
Pharynx/*injuries

Figure

• 

  Fig. 1 (A) Posteroanterior chest X-ray showing linear air trapping parallel to the border of the trachea (arrows), bilateral pleural effusions with consolidation in both lower lungs that was more severe on the left side. (B) Lateral chest X-ray showing a streak of air outlining the posterior pericardium as well as portions of the descending thoracic aorta (arrows).

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  Fig. 2 Chest CT scan showing air collection (arrow) in the mediastinum (A) and bilateral pleural effusions and a collapsed left lower lobe (B). Neck CT scan showing communication (arrow) in the anterior aspect of the pharynx (C). CT, computed tomography.

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