Spontaneous pneumorrhachis associated with pneumomediastinum in a patient with diabetic ketoacidosis: an exceptional manifestation of a benign disease.

An 18-year-old man with a history of type 1 diabetes mellitus presented with a sudden onset of retrosternal pain and dyspnea, preceded by a 3-day history of severe vomiting. The patient denied any fever but complained of new-onset headache. His vitals signs were normal. Physical examination revealed a dehydrated patient with cervical subcutaneous emphysema and Hamman’s crunch sign. There were no meningeal irritation signs. Laboratory tests showed important hyperglycemia and diabetic ketoacidosis (DKA). Chest radiograph and CT revealed massive pneumomediastinum with bilateral cervical subcutaneous emphysema. (Fig. 1). No pneumothorax or pleural effusion were noted. Boerhaave’s syndrome was ruled out with contrast studies. A CT of the chest further documented the presence of an important pneumorrhachis (Fig. 2). The patient was admitted for observation. All symptoms resolved within 48 hours, and serial chest radiographs documented regression of the pneumomediastinum. Discussion