An unusual case of spontaneous pneumomediastinum
In an unusual case, a man tore his lung while masturbating. The 20-year-old presented to the emergency department with severe shortness of breath and chest pain. A tear in the lung or spontaneous pneumomediastinum is a rare condition that affects young men following a benign and self-limiting course. Whereas secondary pneumomediastinum is triggered by trauma, oesophagal perforation and iatrogenic intervention. The third variant, spontaneous pneumomediastinum is caused by strenuous physical exercise, excessive vomiting and violent coughing.
It occurs when there is an abrupt increase in intrathoracic pressure that causes an alveolar rupture and air leak along the tracheobronchial tree into the mediastinal cavity. This article highlights a case of spontaneous pneumomediastinum and profound subcutaneous emphysema in a healthy young man during masturbation. However, because of a lack of literature on spontaneous pneumomediastinum with autoerotic experiences, this is considered an unusual case.
The emergency department admissions of spontaneous pneumomediastinum (SPM) are 1 in 10,500 to 1 in 30,000. It is a rare condition that commonly affects young men in their twenties. It can be triggered by a variety of conditions, for example, acute asthma exacerbation, violent coughing or excessive vomiting and strenuous physical activity. It is unlikely to be caused by trauma, iatrogenic intervention or oesophagal perforation. It is thought to be a result of a high pulmonary pressure gradient which causes alveolar rupture and air leakage into the mediastinal cavity. Extended spontaneous pneumomediastinum goes along with subcutaneous emphysema with the typical symptoms of dyspnoea, chest pain, neck pain and crepitations. The condition follows a benign and self-limiting course and there is no treatment required.
Case report
A 20-year-old was referred to the emergency department with severe dyspnoea and chest pain. The young man complained of a sudden onset of sharp chest pain with shortness of breath while he was lying in bed masturbating. His medical history was significant for mild asthma. However, he wasn’t on any medication for it. Similarly, he was being treated with Lisdexamfetamine for ADHD. On his arrival at the emergency department, his blood pressure was 140/90 mmHg, heart rate 93/min and 99% oxygen saturation through a non-rebreather mask. His respiratory rate was 22/min, temperature 36.6°C and blood glucose 5.7 mmol/L. He was alert and oriented. He had no history of smoking or drug use. Clinical examination was significant for a swollen face and crackling crepitations from the mandible down the neck and chest to the elbows on both sides. Lung auscultation did not reveal any abnormal findings. Further examination was also unremarkable.
Investigation findings
Laboratory tests showed “leukocytosis with 13,2 G/L with all other measured parameters (haemoglobin, platelet count, sodium, potassium, creatinine, CRP) in the normal range. The patient was immunized against COVID-19 with an mRNA vaccine three times and the SARS-CoV-2-Ag test was negative as well. Chest X-Ray (CXR) revealed subcutaneous emphysema and a computed tomographic (CT) scan of the chest and neck showed profound pneumomediastinum with subcutaneous emphysema reaching up until the base of the skull”. However, because of the high oxygen demand, the patient was admitted to the ICU under observation.
The chest pain was treated successfully with paracetamol. The patient was further given prophylactic antibiotics for 3 days. However, the patient had an uneventful night and was transferred to the general ward a day after. His subcutaneous emphysema subsided, but the chest pain remained for three more days. The emphysema was gone was 4 days of admission and was discharged with no further complications.
The condition can be caused by trauma to the lungs or oesophagus. Other than mild asthma, the patient did not have any other medical conditions that could have caused the condition.
Source: ScienceDirect
