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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.1 Spontaneous pneumomediastinum caused by simple vocal exercises is even more uncommon.2,3 The emphysemas caused by vocal exercises typically resolve without intervention, even if extensive free air has emerged.1-3