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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