Chest pain in an adolescent male

Excerpt

A 15-year-old boy was referred to our emergency department for evaluation of subcutaneous emphysema. The patient had presented with gradual onset of dull resting chest pain lasting for almost an hour. The nature of the pain subsequently changed to sharp and radiated to his throat. He had undergone a chest X-ray at the outside emergency department which was remarkable for subcutaneous emphysema. Laboratory evaluation revealed no abnormality. He was subsequently transferred to our emergency department without any further intervention. The patient was symptom free upon arrival. He denied any history of trauma or prior such episodes. Physical examination revealed a well appearing male, alert, oriented, and in no acute distress with palpable subcutaneous emphysema over the right trapezius muscle and neck. A computed tomography (CT) scan of the chest was obtained (Figs. 1 and 2). Chest CT confirmed the presence of subcutaneous emphysema as seen in Fig. 1 (arrowhead). There was additional evidence of extensive pneumomediastinum (white arrow). There was no pneumothorax, obvious esophageal or tracheolaryngeal perforation, or fistula.

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