Spontaneous Retropharyngeal and Mediastinal Emphysema

Abstract

A 14-year-old girl with no significant medical history presented at Emergency Department with sore throat and odynophagia after one episode of nonviolent coughing. She denied any respiratory distress, voice change, foreign body ingestion, retching, substance abuse, dental procedures, or trauma. She was afebrile with normal oxygen saturation and physical examination including the head and neck was unremarkable with the exception of bilateral neck crepitus without tenderness on palpation. Fiberoptic laryngoscopy revealed a patent laryngeal airway with normal vocal fold movement. Lateral neck X-ray demonstrated a linear air-column in the retropharyngeal space and computed tomography confirmed emphysema involving the retropharyngeal space and mediastinum with no evidence of fluid collection or abscess formation. Spontaneous retropharyngeal and mediastinal emphysema are clinical entities where free air is present within the confines of retropharyngeal space and mediastinum without obvious cause. It is benign and self-limited in nature and allows for conservative management. This case is presented with a review of literature.

A Rare Complication of Asthma: Retropharyngeal Emphysema, Subcutaneous Emphysema, and Pneumomediastinum

“…Asthma has also been rarely implicated in these cases, due to the forced inhalation/severe coughing seen in asthma exacerbations. Overall, SPM is a rare entity and has a reported incidence of 1 in 45,000, with a male preponderance (76%) [1][2][3].…”

“…The gas produced internally, during a pneumomediastinum, can track from the mediastinum to the subcutaneous tissues, usually of the neck and chest. This gas may also make its way into the retropharyngeal fascia, producing a rare clinical picture of retropharyngeal emphysema (RPE) [1][2][3][4][5].…”

“…A literature review revealed only a handful of cases reporting the occurrence of SE and SPM in the setting of various respiratory viral infections and only one pediatric case that describes these complications in the setting of rhinovirus infection. No adult cases have been reported [1][2][3][4]. Furthermore, the synchronous presentation of RPE, SPM, and SE has rarely been reported in the setting of asthma.…”

Spontaneous pneumomediastinum, pneumoretroperitoneum, and cervicofacial subcutaneous emphysema after repeatedly and forcefully blowing into a bottle

“…Risk factors for bronchial hyper-reactivity are asthma and inhalation of illicit drugs (e.g., cocaine (4) and marijuana). Barotrauma may result from instrumentation, mechanical ventilation, or Valsalva's maneuver, which is the process of expiration through resistance that increases intra-thoracic pressure during coughing (5), straining during labor (6), or vomiting (2). Blowing into a closed space such as a bottle is also considered as a Valsalva's maneuver.…”

Odynophagia and neck pain after exercise

“…Valsalva manoeuvre (eg, induced by physical exercise) can be a trigger. Typical symptoms include dyspnoea and retrosternal pleuritic pain 2. The authors want to emphasise the fact that SPM can present with head and neck complaints, with less obvious respiratory symptoms.…”