A 27-year-old man presented himself because he was experiencing acute, respiratory-dependent left-sided chest pain when swallowing food. A history of chronic renal failure with IgA nephropathy and well-controlled bronchial asthma was known. The vital signs and the electrocardiogram were normal, and the clinical examination showed crackle in the neck. The chest X-ray and subsequent computed tomography showed pronounced pneumomediastinum with pneumopericardium, narrow ventral mantle pneumothorax on the left and soft tissue emphysema on the right cervical. A leakage of contrast medium into the mediastinum was not observed. Esophagogastroscopy revealed intact mucous membranes. The patient was treated symptomatically; the radiological control after five days showed clearly regressive pneumomediastinum with residual air accumulation in the cervical region. Spontaneous pneumomediastinum is relatively rare entity (estimated incidence 1: 7,000 to 1:45,000) with common occurrence in young men and is largely self-limiting. The endoscopic examinations are not absolutely necessary for clinically stable patients.
PD Dr. med. Radovan Vasko, Prof. Dr. med. Gerhard Anton Müller, Clinic for Nephrology and Rheumatology, Georg-August-Universitat Göttingen, vaskorad@gmail.com
Conflict of interest: The authors declare that there is no conflict of interest .
How to quote: Vasko R, Müller GA: A 27-year-old man with abruptly occurring chest pain on swallowing. Dtsch Arztebl Int 2018; 115: 652. DOI: 10.3238 / arztebl.2018.0652
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