Pneumomediastinum as a complication of fast bowling in cricket.

A 15-year-old schoolboy was practising bowling and straining to bowl fast, when he noticed the gradual onset of sharp retrosternal chest pain, aggravated by respiration and eased by lying down. Later the pain radiated to his shoulders and neck, which became swollen. On examination there was a loud pericardial rub and surgical emphysema around the neck and over the anterior chest-wall. There were no stigmata of Marfan's syndrome. Chest X-ray confirmed extensive surgical emphysema in the soft tissues of the neck and right axilla and showed a rim of air along the edge of the pericardium consistent with pneumomediastinum. Subsequent chest X-rays revealed small bilateral apical pneumothoraces which resolved uneventfully over the next three weeks.