CHEST Guidelines-A-17-Year-Old-Male-Subject-With-Chest-Pain,-Worsen

A-17-Year-Old-Male-Subject-With-Chest-Pain,-Worsen

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This case study involves a 17-year-old male with a history of allergic asthma who experienced chest pain, worsening dyspnea, and a rare complication after smoking marijuana and tobacco. He was admitted with symptoms such as dry cough and shortness of breath, and examination revealed tachycardia, a low oxygen saturation of 90%, and signs of respiratory distress including wheezing. Further assessments, including a chest X-ray and CT scan, indicated the presence of subcutaneous emphysema and pneumomediastinum, a condition where air is present in the mediastinum.<br /><br />Notably, an unusual vertical air artifact was identified during a cervical ultrasound, indicating subcutaneous emphysema. The patient also had air extending from the cervical to the thoracic vertebrae, consistent with the Macklin effect, typically linked to traumatic injuries but here associated with asthma exacerbation. Ultrasound emerged as a recommended tool to diagnose spontaneous pneumomediastinum (SPM), minimizing radiation exposure compared to CT scans, yet providing essential diagnostic insights often missed by chest X-rays.<br /><br />The study highlights that SPM is typically benign and managed through supportive care, involving oxygen therapy, bronchodilators, and corticosteroids. In this case, the patient fully recovered with treatment and began a long-term inhaled corticosteroids regimen to manage asthma. The discussion emphasizes the evolving role of point-of-care ultrasound (POCUS) in diagnosing SPM, as it enables rapid identification of hyperechoic artifacts and other signs, offering real-time correlation with clinical status. The study also notes the rare complication of epidural pneumorrhachis (PR) associated with asthma exacerbation in this patient, emphasizing the importance of recognizing these rare occurrences in clinical practice.

Keywords

allergic asthma

chest pain

dyspnea

subcutaneous emphysema

pneumomediastinum

Macklin effect

spontaneous pneumomediastinum

point-of-care ultrasound

epidural pneumorrhachis

asthma exacerbation