Epidural Air in Child with Spontaneous Pneumomediastinum

A 3-year-old boy was seen in the emergency room after his mother noted neck swelling, drooling, and dysphonia. This occurred after a brief coughing episode and one episode of vomiting. Although hewas never diagnosed with asthma, the patient had a history of severe paroxysms of coughing. On examination, he had palpable subcutaneous emphysema of the neck, upper chest, and upper back. There were bilateral rhonchi (low pitched, snore-like sounds) on lung examination. He had no neurologic deficits. A chest X-ray showed significant subcutaneous emphysema of the soft tissues of the neck and chest. A neck and chest computed tomography (CT) scan (►Figs. 1 and 2) showed severe pneumomediastinum with extensive subcutaneous emphysema tracking along the fascial planes of the neck, supraclavicular regions, right upper extremity, anterior chest wall, and epidural space. He underwent an esophagram which was negative for perforation. He was observed in the hospital for a day and discharged to home the next day. During this hospitalization he was diagnosed with asthma and is currently being treated for such.