The common clinical presentation of SPM involves chest pain (89%), dyspnea (67%),dysphagia (18%), and neck pain (11%)(4). Pneumothorax was not observed in our patient. A retrospective review of 62 patients with SPM identified concomitant pneumothorax in 32% of patients. There may have been a high rate of pneumothorax in that study because of the high prevalence of preexisting lung disease and the advanced age of the patients(5)
In this present case, the clinical picture revealed subcutaneous emphysema in the neck and chest wall with crepitus. In one report, the diagnosis of SPM was made by chest radiography alone(6). In another report, 70% of 33 cases of SPM were identified by chest radiograpy and the remaining 30% were discovered by chest CT scan(7).Computed tomography scan of the chest can help establish the diagnosis when chest radiography is ambiguous for identification of SPM.
In a previous review, one of 18 patients with SPM experienced complications and received surgical intervention(4). Jogging-induced pneumomediastinum should be differentiated from other life-threatening conditions such as esophageal rupture or bronchial perforation. It is important to differentiate between SPM and secondary pneumomediastinum, such as Boerhaave syndrome. Secondary pneumomediastinum is associated with traumatic chest injury or intrathoracic disease, and there may be a high incidience of pneumothorax and a poor outcome if not diagnosed immediately. In our patient, SPM and subcutaneous emphysema were rare sequelare after jogging.
The possible pathophysiology in this present case may be the development of increased intrathoracic pressure during jogging(1). In the initial management of this patient, a decision had to be made between emergency diagnostic tests and conservative therapy.
Yellin et al. reported that for a healthy patient with free air in the mediastinum but no pneumothorax, conservative treatment and observation are adequate, and invasive disgnostic tests and surgical intervention are not needed(8). In this present case, conservative treatment was selected.
Antibiotics were not necessary as there was no significant infection. Emergency endoscopic procedures and surgical intervention should be considered if there are dynamic changes in a patient’s clinical condition. Fortunately,
our patient’s clinical course and radiography resolved 3 days after admission. Recurrence of spontaneous pneumomediastinum has been reported(8), but no recurrence was noted in this patient after follow-up for one month.
In conclusion, this is a case of SPM that developed dramatically after jogging. This case illustrates that SPM is benign process with successful resolution after conservative treatment without invasive procedures.
