Spontaneous pneumomediastinum, pneumothorax, pneumorrhachis, pneumoretroperitoneum, surgical emphysema

A 16‐year‐old male patient with biopsy proven cerebral germinoma presented to the emergency department with altered sensorium, swelling, and stiffness of the neck and chest. He was continuously straining manually due to unknown cause. Chest radiograph and computed tomography (CT) revealed pneumomediastinum, pneumothorax, surgical emphysema, pneumorrhachis, and pneumoretroperitoneum. The patient was followed conservatively and completely recovered over the next 15 days. There was no definite cause of spontaneous pneumomediastinum, pneumothorax, surgical emphysema, pneumorrhachis, and pneumoretroperitoneum in this patient. Presumably air leakage was secondary to the excessive elevation of intrathoracic pressure due to manual straining which is an uncommon cause and remains largely underdiagnosed clinically, especially in young, healthy patients. On examination, subcutaneous crepitations were palpable across his neck and the superior part of his chest.