Pneumomediastinum and subcutaneous emphysema without pneumothorax in an asthmatic patient

Pneumomediastinum with subcutaneous emphysema is caused by a sustained increase in the alveolar and intrabronchial pressure due to asthmatic bronchospasm, physical activity and excessive coughing or vomiting. Pneumomediastinum should be considered in the differantial diagnosis of chest pain in healthy adolescents and young adults. Chest Xray and computerized tomography (CT) were diagnostic in all cases. A 68-year-old asthmatic male was admitted to our department with sudden onset, severe chest and back pain and dyspnea that developed during excessive coughing. The chest X-ray was normal. CT of the thorax, when performed, revealed the diagnosis of pneumomediastinum and subcutaneous emphysema and a fracture on the 8th rib posteriorly. Interestingly there was neither pneumothorax nor haemothorax.