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Spontaneous pneumomediastinum: an important differential in acute chest pain
  1. Francesca Hogan1,
  2. Chris McCullough2,
  3. Asif Rahman2
  1. 1Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  2. 2Department of Emergency Medicine, St Mary's Hospital, London, UK
  1. Correspondence to Dr Francesca Hogan, francesca.hogan{at}


A 38-year-old man presented with pleuritic chest pain that was present on waking and localised to the left costal margin with no radiation. He was otherwise asymptomatic and denied preceding trauma, heavy lifting, coughing or recent vomiting. Observations and examination were unremarkable; however, a chest radiograph showed a pneumomediastinum. Spontaneous pneumomediastinum (SPM) is a rare condition that tends to follow a benign clinical course. A CT of the chest is generally only indicated if the chest X-ray fails to show an SPM in patients for whom there is a high index of clinical suspicion. A contrast-enhanced swallow study is only indicated if there is suspicion of an oesophageal tear or rupture. Evidence suggests that patients with SPM can be managed conservatively and observed for 24 h.

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