title: Spontaneous pneumomediastinum: an important differential in acute chest pain.
abstract: A 38-year-old man presented with pleuritic chest pain that was present on waking and localised to the left costal margin with no radiation. He was otherwise asymptomatic and denied preceding trauma, heavy lifting, coughing or recent vomiting. Observations and examination were unremarkable; however, a chest radiograph showed a pneumomediastinum. Spontaneous pneumomediastinum (SPM) is a rare condition that tends to follow a benign clinical course. A CT of the chest is generally only indicated if the chest X-ray fails to show an SPM in patients for whom there is a high index of clinical suspicion. A contrast-enhanced swallow study is only indicated if there is suspicion of an oesophageal tear or rupture. Evidence suggests that patients with SPM can be managed conservatively and observed for 24 h.
authors.affiliation: Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Francesca
authors.initials: F
authors.lastname: Hogan
authors.affiliation: Department of Emergency Medicine, St Mary's Hospital, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: McCullough
authors.affiliation: Department of Emergency Medicine, St Mary's Hospital, London, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Rahman
mesh_terms: D000208:Acute Disease; D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D000700:Analgesics / Q000008:administration & dosage; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013902:Radiography, Thoracic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D019980:Amoxicillin-Potassium Clavulanate Combination