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\begin{document}

\title{Pneumomediastinum in a cheerleading student}



\author[1]{Yuichiro Haba}%
\author[1]{Toshio Naito}%
\affil[1]{Juntendo University}%


\vspace{-1em}



  
  \date{May 25, 2024}


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\begin{abstract}
Spontaneous pneumomediastinum in healthy individuals is an uncommon
entity. We are reporting an image of pneumomediastinum and subcutaneous
emphysema in a male college student. The onset was considered to be the
hard vocal exercise during his cheerleading club activity.%
\end{abstract}%



\sloppy


\textbf{Title Page}

\emph{Title of Manuscription} : Pneumomediastinum in a cheerleading
student

\emph{Type:} Clinical Image

\emph{Full names of all authors} :

Yuichiro HABA\textsuperscript{1,2} and Toshio NAITO\textsuperscript{1}

\emph{Affiliations} :

Yuichiro Haba

1. Department of General Medicine, Faculty of Medicine, Juntendo
University, Tokyo Japan. 2 -1-1 Hongo, Bunkyo-ku, Tokyo 113-8421 Japan.
Tel \& Fax: +81-3-5802-1190

2. Department of Emergency and Disaster Medicine, Faculty of Medicine,
Juntendo University, Tokyo Japan. 2 -1-1 Hongo, Bunkyo-ku, Tokyo
113-8421 Japan.

Toshio Naito

1. Department of General Medicine, Faculty of Medicine, Juntendo
University, Tokyo Japan. 2 -1-1 Hongo, Bunkyo-ku, Tokyo 113-8421 Japan.
Tel \& Fax: +81-3-5802-1190

\emph{Corresponding author} :

Yuichiro Haba

Department of General Medicine, Juntendo University School of Medicine,

2 -1-1 Hongo, Bunkyo-ku, Tokyo 113-8421 Japan. Tel \& Fax:
+81-3-5802-1190

E-mail address: yhaba@juntendo.ac.jp

\emph{Numbers of references:} 3

\emph{Numbers of tables:} 0

\emph{Numbers of figures:} 2

\emph{Word length for the article's text:} 195 words

\textbf{Pneumomediastinum in a cheerleading student}

\textbf{Abstract}

Spontaneous pneumomediastinum in healthy individuals is an uncommon
entity. We are reporting an image of pneumomediastinum and subcutaneous
emphysema in a male college student. The onset was considered to be the
hard vocal exercise during his cheerleading club activity.

\textbf{Keywords}

spontaneous pneumomediastinum, vocal exercise

\textbf{Text}

A healthy, 20-year-old man presented with a 1-day history of hoarseness,
neck swelling, throat pain, chest pain, and upper back pain that had
developed suddenly on the day before presentation, while training in
yelling out loud for 6 hours as a member of his college cheerleading
club. On arrival, his respiratory rate was 16/min, and he maintained an
oxygen saturation of 97\% on room air. A crackling sensation was
perceived on palpation of the neck. Hamman's sign was not observed. His
chest radiograph showed pneumomediastinum and diffuse subcutaneous
emphysema (Figure 1). A CT scan showed widespread free air in the
mediastinum and subcutaneous areas of the axilla, neck, and jaw (Figure
2). There was no evidence of pneumothorax or esophageal injury. He was
kept under observation for 5 days in our hospital. A repeat radiograph
obtained 12 days after the first arrival revealed complete resolution of
the free air.

There have been a few reports of pneumomediastinum complicating head and
neck surgeries, dental procedures, or Valsalva
maneuver.\textsuperscript{1} Spontaneous pneumomediastinum caused by
simple vocal exercises is even more uncommon.\textsuperscript{2,3} The
emphysemas caused by vocal exercises typically resolve without
intervention, even if extensive free air has
emerged.\textsuperscript{1-3}

\textbf{Acknowledgment}

None

\textbf{Conflicts of interest}

All the authors have no pertinent conflict of interest to report for
this manuscript.

\textbf{Author contributions}

YH conceived the idea for the document and contributed to the management
of the patient and writing of the manuscript. TN contributed to the
editing of the manuscript.

\textbf{Ethical approval}

This report complies with the provisions of the Declaration of Helsinki.

\textbf{Consent}

Written informed consent to publish this report was obtained from the
patient in accordance with the journal's patient consent policy.

\textbf{References}

1. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal
emphysema. Arch Intern Med. 1984;144:1447-1453.

2. Singla M, Potocko J, Sanstead J, Pepper P. Ooh-rah! An unusual cause
of spontaneous pneumomediastinum. Mil Med. 2012;177:1396-1398.

3. Sherrier D, Lizardo RE. Spontaneous pneumopericardium in a U.S.
marine: do not lose heart. Mil Med. 2020;185:e518-e521.

\textbf{Legends for Figures}

\textbf{Figure 1} : Chest radiograph showing pneumomediastinum (arrows),
and diffuse subcutaneous emphysema in the neck and axillary areas
(arrowheads).

\textbf{Figure 2 (A)} : Coronal view of the chest and neck on CT showing
pneumomediastinum and subcutaneous emphysema of on the neck and axillary
areas.

\textbf{(B)} : Sagittal view of the chest and neck on CT showing free
air in the deep neck areas.

\textbf{Hosted file}

\verb`Mediastinal... Fig 1.pptx`  available at \url{https://authorea.com/users/483153/articles/569406-pneumomediastinum-in-a-cheerleading-student}

\textbf{Hosted file}

\verb`Mediastinal... Fig 2 A-B.pptx`  available at \url{https://authorea.com/users/483153/articles/569406-pneumomediastinum-in-a-cheerleading-student}

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\end{document}

