# Spontaneous Pneumomediastinum Presenting as Dysphonia

## TL;DR

A rare case of spontaneous pneumomediastinum presented with voice issues instead of typical symptoms like chest pain.

## Contribution

This case uniquely highlights dysphonia as a presenting symptom of spontaneous pneumomediastinum.

## Key findings

- Spontaneous pneumomediastinum can present with dysphonia without chest pain or dyspnea.
- A chest radiograph is sufficient for diagnosis in many cases.
- Prompt diagnosis helps avoid overtreatment and monitor for complications.

## Abstract

Spontaneous pneumomediastinum is a rare condition describing air within the mediastinum from a non-traumatic etiology from an intrathoracic or extrathoracic source. It typically affects young men through a mechanism known as the Macklin effect, in which alveolar air travels along bronchovascular sheaths into the mediastinum. There are known predisposing conditions as well as activities that can precipitate spontaneous pneumomediastinum, which is generally self-limited, but in rare circumstances, can lead to serious complications such as tension pneumomediastinum, mediastinitis, and tension pneumothorax. The classic triad of symptoms for this condition includes chest pain, subcutaneous emphysema, and dyspnea. We present a case of spontaneous pneumomediastinum in a 19-year-old male patient with the chief complaint of dysphonia after repeated heavy lifting three days prior to presentation.

Spontaneous mediastinum after heavy lifting has been reported previously; however, our case is unique in that the patient presented with dysphonia without chest pain or dyspnea. This condition is important to keep in mind as spontaneous pneumomediastinum is typically self-limiting and can be managed conservatively, reducing unnecessary resource utilization. A chest radiograph is the diagnostic test of choice, and further diagnostic studies may not be necessary. In our case, aerodigestive injury was ruled out with a swallow study because there was a history of occasional vomiting and an unknown source of pneumomediastinum. Although spontaneous pneumomediastinum more commonly presents with chest pain and dyspnea, it is an overall rare condition and should be considered in cases of dysphonia as well, as in this case. Prompt diagnosis of spontaneous pneumomediastinum is important to both monitor for complications and avoid overtreatment.