title: Spontaneous Pneumomediastinum in Non-Asthmatic Children with Exercise-Induced Bronchoconstriction.
abstract: BACKGROUND
  Subcutaneous emphysema can result from rupture of the respiratory or gastrointestinal systems, commonly occurring after trauma or surgery, as well as from rupture of alveoli as pneumothorax or pneumomediastinum. Spontaneous pneumomediastinum with subcutaneous emphysema is rare in children without chest or neck trauma. Here, we report 2 cases of spontaneous pneumomediastinum with exercise-induced bronchoconstriction.
  
  
  METHODS
  The first case is an 11-year-old boy who presented with neck pain after vigorous exercise. Radiography showed pneumomediastinum. The second case is a 15-year-old boy who presented with pleuritic chest pain and respiratory failure requiring intubation. We extensively investigated the possible causes of pneumomediastinum. Both patients had no history of trauma or asthma, and were diagnosed with exercise-induced bronchoconstriction. They were discharged after conservative treatment, without complication.
  
  
  CONCLUSIONS
  Early recognition and investigation of serious conditions should be promptly done in spontaneous pneumomediastinum patients. Conservative treatment, extensive investigations of predisposing factors, and treatment are important.
authors.affiliation: Division of Pulmonology and Critical Care, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
authors.forename: Nattachai
authors.initials: N
authors.lastname: Anantasit
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
authors.forename: Wiparat
authors.initials: W
authors.lastname: Manuyakorn
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
authors.forename: Nualnapa
authors.initials: N
authors.lastname: Anantasit
authors.affiliation: Department of Pediatrics and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Choong
authors.affiliation: Division of Pulmonology and Critical Care, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
authors.forename: Aroonwan
authors.initials: A
authors.lastname: Preuthipan
mesh_terms: D000293:Adolescent; D001249:Asthma; D016084:Bronchoconstriction; D002648:Child; D005080:Exercise Test / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed