title: Advanced anorexia nervosa, associated with pneumomediastinum, pneumothorax, and soft-tissue emphysema without esophageal lesion.
abstract: OBJECTIVE
  We describe the case of a 20-year-old female patient suffering from anorexia nervosa since the age 15 of years. When admitted, she was 168 cm tall with a weight of 35 kg (body mass index [BMI] = 12.4). A week after admission, the patient complained of retrosternal pain, and a few hours later she developed extensive soft-tissue emphysema.
  
  
  METHODS
  The X-ray picture of her thorax showed left-hand supraclavicular and infraclavicular emphysema, extensive emphysema in both sides of the soft tissue of the throat, a left-hand apical pneumothorax (4 mm), and a pneumomediastinum.
  
  
  RESULTS
  We discuss the extent to which these symptoms are interrelated in the sense of a causal nexus.
  
  
  CONCLUSIONS
  We ruled out any other differential-diagnostic etiopathogenic factors and concluded that the cause of our patient's soft-tissue emphysema, pneumothorax, and pneumomediastinum might well be autodestructive behavior.
authors.affiliation: Department of Psychosomatic Medicine, Charité, Berlin, Germany. gerhard.danzer@charite.de
authors.forename: Gerhard
authors.initials: G
authors.lastname: Danzer
authors.forename: Johanna
authors.initials: J
authors.lastname: Mulzer
authors.forename: Gerrit
authors.initials: G
authors.lastname: Weber
authors.forename: Alexander
authors.initials: A
authors.lastname: Lembke
authors.forename: Rüya
authors.initials: R
authors.lastname: Kocalevent
authors.forename: Burghard F
authors.initials: BF
authors.lastname: Klapp
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications* / Q000473:pathology; D018450:Disease Progression; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008478:Mediastinal Emphysema / Q000209:etiology*; D013902:Radiography, Thoracic; D012188:Retropneumoperitoneum / Q000209:etiology*; D013352:Subcutaneous Emphysema / Q000209:etiology*