Cough induced pneumomediastinum due to tracheal tear

Spontaneous pneumomediastinum associated with subcutaneous emphysema following a sudden bout of cough is rare. Most of such pneumomediastinum would be associated with pneumothorax and would be a result of the ruptured pulmonary alveolus. Here, authors report a case of a 20-year-old male who developed swelling of neck and chest tightness following a sudden bout of cough. On examination, he was haemodynamically stable but had diffuse subcutaneous emphysema involving the neck and the upper chest. Radiology revealed pneumomediastinum without any pneumothorax. Authors think that the tracheal tear is the probable cause of air leak into soft tissue of the neck and the mediastinum. The patient was managed conservatively by close monitoring and supportive care. In patients with no prior underlying chest disease, and in those with no progressive respiratory distress, conservative treatment with cautious observation can successfully resolve this condition. This is a unique report, which attributes spontaneous pneumomediastinum without pneumothorax to the breach in the trachea.