Pneumomediastinum with Ascending Emphysema within the Spinal Canal

A 16-year-old boy vomited due to heatstroke during a soccer game but continued to train hard after the game. He was admitted to our hospital for chest discomfort three days later. Chest radiograph demonstrated pneumomediastinum, and computed tomography of the neck revealed emphysema within the spinal canal (Picture 1A) at cervical level 5 (Picture 1B, red arrows). Barium esophagography revealed no fistulas. He was diagnosed with spontaneous pneumomediastinum and treated conservatively by bed rest. Five days after admission, he was discharged from our hospital. Although a previous study reported that pneumomediastinum patients occasionally have emphysema within the spinal canal (1), emphysema up to cervical level 5 is extremely rare. This rare condition was thought to be an aftereffect of emphysema within the mediastinum through the intervertebral foramen (Picture 2, red arrows) ascending to the spinal canal due to continuous hard excise.