DOI: https://doi.org/10.36347/sjmcr.2026.v14i10.051

Pages: 3346-3349

Spontaneous pneumomediastinum (SPM) is a rare and usually benign condition defined by free air in the mediastinum in the absence of trauma, surgery, or hollow-organ perforation. We report the case of a 22-year-old man with known asthma, treated with an on-demand short-acting β2-agonist, who was admitted for sudden-onset respiratory distress. He was conscious, with a respiratory rate of 40 breaths/min, an oxygen saturation of 92% on room air, suprasternal retraction, and cervical swelling with subcutaneous emphysema. Pulmonary auscultation was normal and hemodynamics were stable. Chest radiography was followed by chest computed tomography, which confirmed the diagnosis. The patient was admitted to the intensive care unit for close monitoring and received high-concentration oxygen by mask and intravenous analgesia. The clinical course was favorable, with complete resorption of the pneumomediastinum within 7 days and no invasive or surgical procedure. SPM should be considered in any young asthmatic patient with sudden respiratory distress, particularly when cervical subcutaneous emphysema is present. Chest radiography guides the diagnosis, whereas computed tomography is the reference examination to confirm it and to exclude tracheobronchial or esophageal perforation. Conservative management with close monitoring is usually sufficient.