Unusual cause of pneumomediastinum

Description 

A 25-year-old man presented to the emergency department reporting a 6-hour history of progressive neck swelling associated with a single episode of chest pain. He had no significant medical history. He initially denied any illicit drug use.

On examination, the neck was visibly distended with palpable crepitus that extended to the upper torso. Cardiorespiratory examination was otherwise unremarkable. He was systemically well and routine observations were normal. The ECG showed widespread concave ST elevation suggestive of pericarditis. The chest radiograph demonstrated pneumomediastinum. A CT scan of the neck and thorax revealed widespread surgical emphysema along the thoracic wall, extending through the mediastinum, upwards into the neck involving both superficial and deep compartments (figure 1) up to the skull base (figure 2). No pneumothorax was seen. The white blood cell count was mildly raised at 17.7x10⁹/L, C reactive protein was 24 mg/L and troponin was...

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