title: [Spontaneously occurring pneumomediastinum related to a pneumopericardium, a pneumothorax and a skin emphysema in a 12-year old boy].
abstract: BACKGROUND
  The spontaneous pneumomediastinum describes the existence of air inside the mediastinum, is caused by an alveolar rupture in most cases and occurs without influence of traumata, surgery or iatrogen interferences. This is a rare and, in most cases, benign disease. An association between a pneumomediastinum, a pneumopericardium, a pneumothorax, as well as a skin emphysema, is extremely rare in children and young adults.
  After doing sports a 12-year-old boy with a bronchial asthma history complained about acute thoracic pain and dyspnea. Later on, the boy noticed a breathing sound based on his breathing cycle and skin emphysema at the left side of his thorax and neck, which was not painful. Based on the anamnesis, the clinical examination, the results of different diagnostic methods, including a thoracic X-ray in 2 levels, the boy was diagnosed with an acute spontaneous pneumomediastinum in association with a pneumopericardium, a pneumothorax and a skin emphysema. After diagnostic validation and exclusion of different diagnoses as well as an osseous chest trauma, the 12-year old patient was treated symptomatically. A complete absorption of the different air leaks could be described.
  
  
  CONCLUSIONS
  In this case report and literature review possible causes, differential diagnoses, and treatments are summarized. Based on this, we suggest that this case report serve as a diagnostic guide for patients presenting with these symptoms.
authors.affiliation: University of California San Diego, Department of Medicine, La Jolla, California, USA. claudia.eberle@med.uni-muenchen.de
authors.forename: Claudia
authors.initials: C
authors.lastname: Eberle
authors.forename: K
authors.initials: K
authors.lastname: Jünger
authors.forename: K-M
authors.initials: KM
authors.lastname: Debatin
authors.forename: M
authors.initials: M
authors.lastname: Wabitsch
mesh_terms: D001250:Asthma, Exercise-Induced / Q000150:complications* / Q000175:diagnosis; D001642:Bicycling; D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000209:etiology* / Q000628:therapy; D011026:Pneumopericardium / Q000209:etiology* / Q000628:therapy; D011030:Pneumothorax / Q000209:etiology* / Q000628:therapy; D012075:Remission, Spontaneous; D013352:Subcutaneous Emphysema / Q000209:etiology* / Q000628:therapy; D013550:Swimming