DOI: https://doi.org/10.36347/sasjm.2026.v12i09.020

Pages: 932-935

Spontaneous pneumomediastinum (SPM) is an uncommon condition characterized by the presence of free air within the mediastinum in the absence of trauma, surgery, or other iatrogenic causes. Although generally benign and self-limiting, it may complicate acute asthma and can present with extensive subcutaneous emphysema. We report the case of a 19-year-old man with recently diagnosed asthma who developed extensive spontaneous pneumomediastinum during an acute exacerbation triggered by a probable viral respiratory infection. The patient had discontinued his inhaled corticosteroid/long-acting beta-agonist treatment two months before admission. He presented with progressive dyspnea, dry cough, low-volume hemoptysis, and extensive subcutaneous emphysema involving the neck, trunk, back, and upper limbs. Chest radiography demonstrated pneumomediastinum and extensive subcutaneous emphysema without pneumothorax. Thoracic computed tomography confirmed extensive mediastinal and subcutaneous air and excluded tracheal or esophageal rupture. Bronchoscopy showed no tracheobronchial abnormality. The patient was managed conservatively with oxygen, nebulized bronchodilators, systemic corticosteroids, and close clinical monitoring. Thoracic surgery was consulted because of the extent of the pneumomediastinum and the potential risk of airway compression. The patient improved progressively and was discharged on the sixth hospital day. This case highlights the importance of considering SPM in patients with acute asthma who develop atypical respiratory or subcutaneous findings. Early recognition and appropriate imaging can establish the diagnosis and help exclude potentially life-threatening secondary causes.