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Case report
Spontaneous pneumomediastinum: an unusual complication of hyperemesis gravidarum
  1. David Foley,
  2. Heather J Holmes and
  3. Robert P Kauffman
  1. Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas, USA
  1. Correspondence to Dr Robert P Kauffman; robert.kauffman{at}ttuhsc.edu

Abstract

A 21-year-old first trimester primagravida woman with hyperemesis gravidarum was noted to have incidental subcutaneous emphysema during thyroid ultrasound. Follow-up radiograph demonstrated supraclavicular subcutaneous emphysema, left apical pneumothorax and pneumomediastinum. The patient was transferred to the intensive care unit and evaluated for esophageal rupture. Because no defects were seen on swallow studies/endoscopy and the patient was stable, she was treated conservatively with antibiotics and monitored. The patient’s condition improved, and she was discharged on hospital day 6. Subcutaneous emphysema secondary to hyperemesis gravidarum is a rare but potentially life-threatening condition in which the source of the mediastinal leak needs to be immediately determined. After the more serious sources of mediastinal air have been excluded, conservative management is suitable.

  • pregnancy
  • materno-fetal medicine
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Footnotes

  • Twitter @rkauffmd

  • Contributors HJH participated in the management of the patient and materially contributed to the preparation of the manuscript. DF and RPK materially contributed to manuscript preparation and background research. Figures were formatted by RPK, RPK is a BMJ fellow.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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