Cervical subcutaneous emphysema and pneumomediastinum after sneezing.

A 20-year-old Chinese man, with a history of chronic rhinitis, was admitted to our hospital in July 2011, with sudden severe non-radiating retrosternal chest discomfort. He had had a recent upper respiratory tract illness with sore throat and running nose that induced forceful sneezing. He denied any accidental trauma to the chest. On admission, the respiratory rate was 18 breaths/min, oxygen saturation was 98% on room air, blood pressure 110/60 mm Hg, pulse rate 80 beats/min, and body temperature 37°C. Physical examination revealed bilateral cervical subcutaneous emphysema, spreading to both supraclavicular fossae, while oro-laryngopharyngeal, chest and cardiovascular examination revealed no abnormality. Findings from blood test (including complete blood picture, and renal and liver function test) were unremarkable. The chest X-ray (CXR) showed subcutaneous emphysema in the supraclavicular fossae, with air tracking into the neck area bilaterally and a strip of para-aortic air on the left side (Fig 1). The trachea was central and the lung fields and cardiac silhouette were normal. Contrast-enhanced neck and thoracic computed tomography revealed extensive cervical surgical emphysema and pneumomediastinum (Fig 2). There was no abnormal soft tissue swelling or mass noted in the oro-nasopharynx. The diagnosis was cervical subcutaneous emphysema and pneumomediastinum was caused by forceful sneezing. The patient was managed conservatively without complications and the follow-up CXR 2 weeks later showed complete resolution of the subcutaneous emphysema and pneumomediastinum.