title: Teenager with chest pain and swollen neck: a leave-it-alone condition.
abstract: A 19-year-old boy with shortness of breath and chest pain after strenuous exercise presented to emergency department . On physical examination, the neck and shoulders appeared to be swollen. There was crepitus on skin palpation. Chest X-ray disclosed diffuse subcutaneous emphysema and pneumomediastinum. CT showed additional finding of air in epidural space. The patient was discharged after 2 days of hospitalisation with conservative treatment uneventfully. Pneumorrhachis is usually caused by abrupt increase in intrathoracic pressure in instance of forceful vomiting, cough or asthma attack in an otherwise healthy young adult. It is usually accompanied with pneumomediastinum. The management of epidural pneumatosis should be tailored according to its primary cause. For most patients with pneumorrhachis associated to a spontaneous pneumomediastinum without neurological symptoms, this condition is generally self-limited. For epidural free air of large volume that causes neurological deficits, surgical laminectomy may be indicated.
authors: Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan Imaging Research Center, Taipei Medical University, Taipei, Taiwan Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.
authors: Pen-Yuan
authors: PY
authors: Liao
authors: Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.
authors: Hung-Jung
authors: HJ
authors: Wang
mesh_terms: D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000150:complications / Q000000981:diagnostic imaging*; D009333:Neck / Q000000981:diagnostic imaging; D013352:Subcutaneous Emphysema / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Asthma