Spontaneous pneumomediastinum

A 20-year-old man with asthma presented with a 5-day history of coughing bouts and pleuritic chest pain, and a 2-day history of neck swelling and breathlessness. On examination, he had mild tachypnoea with no stridor, and had subcutaneous emphysema from the anterior neck, down to the infraclavicular regions and into the right arm. Auscultation revealed widespread rhonchi and prolonged expiratory phase. X-rays revealed extensive pneumomediastinum (Figure, A) and subcutaneous emphysema (Figure, B). He was managed with high flow oxygen, nebulised bronchodilators and intravenous steroids and was discharged at 10 days of follow-up.