A Very Rare Complication Due to Cough in Pediatric Emergency Clinic: Spontaneous Pneumomediastinum and Diffuse Subcutaneous Emphysema

Pneumomediastinum is the presence of free air in the mediastinum. Spontaneous pneumomediastinum (SPM) occurs when air enters the interstitial space and mediastinum as a result of rupture of the alveoli in cases of increased intrathoracic pressure such as asthma and lung infection. A 3-year-old girl was admitted to the Pediatric Emergency Department with cough. On physical examination, his general condition was moderate and he had groaning due to respiratory distress. Pulmonary sounds were decreased on the left side with auscultation and rhonchus on the right side. Bilateral crepitation was detected between chest and shoulder. After imaging, SPM, retrosternal emphysema, subcutaneous emphysema and minimal pneumothorax were detected in the chest and neck region. The patient was admitted to the Pediatric Intensive Care Unit for further follow-up and treatment. Our patient was followed up in the intensive care unit for two days and inpatient service for two days and discharged without any complication with conservative treatment. We suggest that patients with a diagnosis of SPM should be followed for at least 24 hours in terms of complications and prophylactic antibiotics should be given to prevent the development of mediastinitis.

Keywords: Subcutaneous emphysema, Cough, Pneumomediastinum.