TY - JOUR T1 - Spontaneous pneumomediastinum in accidental chlorine gas inhalational injury: case report and review of literature JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2020-236549 VL - 14 IS - 7 SP - e236549 AU - Safia Akhlaq AU - Taymmia Ejaz AU - Adil Aziz AU - Arslan Ahmed Y1 - 2021/07/01 UR - http://casereports.bmj.com/content/14/7/e236549.abstract N2 - A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum. CT neck and chest was done, which revealed subcutaneous emphysema and pneumomediastinum and a linear air density in close approximation to right posterolateral wall of trachea at the level of superior margin of sternum was reported. These findings raised the possibility of tracheal injury which was later confirmed by fiberoptic laryngoscopy. The patient was intubated due to hypercapnic respiratory failure resulting from hypoventilation and respiratory distress. Bilateral chest tube insertion was done due to worsening subcutaneous emphysema, high ventilator parameters and prevention of progression to pneumothorax. He was extubated after 5 days; bilateral chest tubes were removed before discharge and underwent uneventful recovery. ER -