title: [Pneumomediastinum: an extremely rare affection. A case of deferred diagnosis. Literature review and the role of thoracic US in urgency].
abstract: OBJECTIVE
  Early identification of spontaneous pneumomediastinum can be achieved by thoracic ultrasound in emergency.
  
  
  METHODS
  A spontaneous pneumomediastinum in a 24 -year old man is reported.
  
  
  RESULTS
  The patient, who refused hospitalization, returned 12 hours later, complaining a massive subcutaneous emphysema, with a mild dyspnea. Thoracic CT confirmed suspected pneumomediastinum and the young man has been transferred to specialized DEA, with a good outcome by conservative treatment.
  
  
  CONCLUSIONS
  Revaluation of the patient has been useful to critically analyze the unusual echographic report too. The major sensitivity and specificity of thoracic US, compared to conventional supine X-ray, is more and more appreciated, regarding occult pneumothoraces. Furthermore the recruitment of training to detect penumomediastinum is needed.
  
  
  CONCLUSIONS
  Spontaneous pneumomediastinum is an extremely rare benign complications of chronic asthma in young population, caused by increased alveolar pressure, instrumental investigation may be supported by US in emergency too, associated to conventional X-ray and CT.
authors.affiliation: S.O.C. Medicina e Chirurgia d'Accettazione e d'Urgenza - Pronto Soccorso Chirurgico, ASL Roma G, P.O. "Parodi Delfino" Colleferro, Roma. Volkswagen0@gmail.com
authors.forename: Antonella
authors.initials: A
authors.lastname: Russo
authors.forename: Carlo
authors.initials: C
authors.lastname: Giangregorio
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications*; D057210:Delayed Diagnosis; D004452:Echocardiography; D004630:Emergencies; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D011237:Predictive Value of Tests; D035583:Rare Diseases / Q000000981:diagnostic imaging; D012075:Remission, Spontaneous; D012680:Sensitivity and Specificity; D013352:Subcutaneous Emphysema / Q000209:etiology; D014057:Tomography, X-Ray Computed