A 27-Year-Old Man With Abruptly Occurring Chest Pain on Swallowing
A 27-year-old man complained of sudden, left-sided, respiration-related thoracic pain every time he swallowed food or drink. He was known to have a history of chronic renal insufficiency with IgA nephropathy and well-controlled bronchial asthma. His vital signs and electrocardiographic findings were normal, but a rale was detected on palpation of the neck. Thoracic radiography and subsequent computed tomography show marked pneumomediastinum with pneumopericardium, a small, left-sided ventral pneumothorax, and right-sided cervical soft-tissue emphysema. No contrast medium was observed in the mediastinum. Esophagogastroscopy showed intact mucosae. The patient received symptomatic treatment, and radiological follow-up 5 days later revealed clear regression of the pneumomediastinum with residual cervical air pockets. Spontaneous pneumomediastinum is a relatively rarely occurring entity (estimated incidence 1:7000 to 1:45 000) that is seen most frequently in young men and is generally self-limiting. Endoscopy is not absolutely necessary in a clinically stable patient.
PD Dr. Radovan Vasko, Prof. Gerhard Anton Müller, Klinik für Nephrologie und Rheumatologie, Georg-August-Universität Göttingen, firstname.lastname@example.org
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare
Cite this as: Vasko R, Müller GA: A 27-year-old man with abruptly occurring chest pain on swallowing. Dtsch Arztebl Int 2018; 115: 652. DOI: 10.3238/arztebl.2018.0652