Case of Pneumomediastinum and subcutaneous emphysema due to foreign body aspiration in child

Dr Mounir Bourrous at Department of Paediatric Emergency, UHC Mohamed VI, Cadi Ayyad University, Faculty of medicine and pharmacy, Marrakech, Morocco and colleagues have reported a rare case of Pneumomediastinum and subcutaneous emphysema due to foreign body aspiration in child: case report.The case has appeared in the Journal of Medical Case Reports.

Pneumomediastinum (PM) is defined as the presence of free air in the mediastinum. Caused by a perforation of the tracheobronchial tree, it occurs in any condition that creates a gradient between intra-alveolar and perivascular interstitial pressures. Subcutaneous emphysema (SCE) results when air dissects along planes of the mediastinum to the subcutaneous tissues of the thorax, neck, and upper limbs. PM rarely occurs in children and is generally a benign entity that requires supportive care

Exacerbations of asthma constitute the most common cause of pneumomediastinum and subcutaneous emphysema in children. Foreign body aspiration is a rare cause of pneumomediastinum and subcutaneous emphysema. Foreign body aspiration leading to the occurrence of pneumomediastinum in a child with asthma may go unnoticed and be wrongly attributed to asthma, which leads to delayed diagnosis as well as to life-threatening and long-term complications.

The authors have described a case of a 6-year-old Moroccan boy with asthma who was admitted to our emergency department for acute dyspnea and persistent dry cough. The patient was initially treated as having acute asthma exacerbation. Owing to insufficient clinical and radiographic improvement with asthma treatment, a rigid bronchoscopy under general anesthesia was performed. A pumpkin seed was removed from the left main bronchus. Clinical and radiographic improvement was achieved after foreign body extraction.

This case emphasizes that the possibility of foreign body aspiration should always and carefully be considered by the emergency physician when faced with a child with asthma presenting with pneumomediastinum and subcutaneous emphysema as an important differential diagnosis even in the absence of a history of foreign body aspiration.