Letter to the Editor

An Overlooked Differential Diagnosis of Acute Chest Pain

Authors: Gautham Viswanathan, MD, Sankar D. Navaneethan, MD, MPH

Abstract

To the Editor:


Spontaneous pneumomediastinum (SPM) is a well-known entity that presents with acute chest pain, dyspnea and subcutaneous emphysema. It typically occurs after maneuvers that increase intrathoracic pressure, such as vomiting, retching, sneezing, childbirth, and straining at stool. The other known causes of SPM include asthma, interstitial lung disease and inhalational drug use.1–3Differential diagnosis of acute chest pain often does not include pneumomediastinum, especially in the primary care setting. We describe a patient who presented to her primary care physician with acute chest pain and was diagnosed with pneumomediastinum after an extensive workup.

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References

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2. Langwieler TE, Steffani KD, Bogoevski DP, et al. Spontaneous pneumomediastinum. Ann Thorac Surg 2004;78:711–713.
 
3. Salzman GA, Khan F, Emory C. Pneumomediastinum after cocaine smoking. South Med J1987;80:1427–1429.
 
4. Gotway MB, Marder SR, Hanks DK, et al. Thoracic complications of illicit drug use: an organ system approach. Radiographics 2002;22:S119–S135.
 
5. Maunder RJ, Pierson DJ, Hudson LD. Subcutaneous and mediastinal emphysema: pathophysiology, diagnosis, and management. Arch Intern Med 1984;144:1447–1453.