Bloomfield Hills, MI
Correspondence to: Jane Krasnick, MD, Allergy and Asthma Specialists of Bloomfield Hills, 43750 Woodward, Suite 101, Bloomfield Hills, MI 48302; e-mail: firstname.lastname@example.org
Spirometry is a simple and common procedure performed to access
pulmonary lung function. Complications from testing are rare but can
include dizziness from hyperventilation, and vasovagal reactions. The
development of pneumomediastinum following spirometric testing has also
been previously reported in two normal subjects1–2 and in
one immunocompromised patient with presumed Pneumocystis
Patients undergoing spirometry are instructed to take a deep
inspiration to total lung capacity and then to expire vigorously. This
causes a rapid increase in lung volume and pressure changes in the
alveolus. These sudden changes in alveolar volume and transpulmonary
pressure can lead to alveolar rupture and subsequent air entry into the
We report a 32-year-old white man who developed a pneumomediastinum
after undergoing spirometry. The patient had a history of perennial
allergic rhinosinusitis and had complained of vague and intermittent
upper-chest tightness for several months. He denied any gastric reflux
Spirometry was performed before and after administration of nebulized
levalbuterol hydrochloride (0.63 mg) and findings were normal. Two
hours later, he developed severe throat and neck pain. He also had a
change in his voice to a high-pitched voice. Physical examination noted
palpable crepitus in the neck. A high-resolution CT scan of the chest
was obtained to excluded underlying parenchymal lung disease. The only
abnormality was the pneumomediastinum (Fig 1).
All symptoms resolved within 36 h. The chest radiograph finding
was normal 5 days later.
Although spirometry is a safe and useful test, one should be aware
of the physiologic changes that occur in the respiratory tract with the
vigorous straining required to complete the test. Furthermore, one
should suspect pneumomediastinum as a complication if the patient
complains of severe neck or throat pain following the procedure.
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