A 27-year-old man who smoked 10 cigarettes per day and had been
treated for epilepsy since childhood was admitted to the hospital on
November 3, 1997, complaining of sudden odynophagia, dyspnea, and
cervicofacial emphysema. No history of trauma or surgery was reported.
The initial physical examination showed important cervicofacial and
thoracic subcutaneous emphysema. Results of the esophagogram,
otolaryngologic examination, and bronchoscopy performed in the
emergency department were normal. The initial chest radiograph
showed subcutaneous emphysema in the cervicofacial, thoracic, and
axillary regions with no evidence of rib fracture. The chest CT
performed a few days later demonstrated air in the subcutaneous,
visceral, and carotid spaces of the neck (Fig 1
, top), extending along the anterior mediastinal space down to the
aortic arch. A small right pneumothorax that collapsed the middle lobe
slightly was also observed (Fig 1, bottom; arrows).
Antibiotic therapy was administered to prevent
mediastinitis, and the patient’s condition improved, making it
possible for him to return to the prison.