# Recurrent Spontaneous Pneumomediastinum in an Adolescent Competitive Swimmer: A Case Report

## TL;DR

A teenage swimmer had three episodes of spontaneous pneumomediastinum, and the paper suggests that avoiding breath-holding and targeted rehabilitation may help prevent recurrence.

## Contribution

The paper presents a novel case report and management strategy for recurrent spontaneous pneumomediastinum in a competitive swimmer.

## Key findings

- A 14-year-old swimmer experienced three episodes of SPM over seven months.
- Restricting breath-holding and undergoing respiratory rehabilitation led to no recurrence.
- The case suggests prolonged activity restriction and targeted rehabilitation may be necessary for SPM prevention in breath-hold athletes.

## Abstract

Spontaneous pneumomediastinum (SPM) is a rare, usually self-limited condition in children and adolescents. Sports-related cases are generally considered benign, with early return to play often recommended. However, evidence to guide management in athletes who rely heavily on breath-holding, such as competitive swimmers, is limited. We report a 14-year-old male competitive swimmer who experienced three episodes of SPM over seven months. His initial presentation involved acute anterior chest pain with stable vital signs and mediastinal emphysema on CT. He improved with conservative treatment and returned to full training within one month, avoiding intense breath-holding for two weeks. A second presumptive episode occurred four months later, followed by a third episode three months after that, again with mediastinal emphysema on imaging. We hypothesized that persistent local tissue vulnerability, possibly incomplete healing of prior microinjury, together with rapid resumption of breath-hold training, contributed to recurrence. After the third episode, all training was restricted for two months, during which he completed supervised stretching and diaphragmatic breathing rehabilitation, followed by a gradual return to swimming while avoiding prolonged breath-holding. He has remained free of recurrent SPM. This case suggests that athletes who perform intense breath-holding may require more prolonged activity restriction, targeted respiratory rehabilitation, and explicit limitations on breath-holding to reduce the risk of SPM recurrence.