EC Pulmonology and Respiratory Medicine

Pneumomediastinum is the presence of air in the mediastinal space, it can be spontaneous or secondary to thoracic pathology or trauma. the diagnosis and management must be rapid to avoid complications.

A 30-year-old man was admitted to the pneumology department for dyspnoea, general fatigue and weight loss. Physical examination reveals rales and crackles in both lung fields, with hypoxia. An infectious syndrome on the biological balance sheet, in particular a high PCR, white blood cells and procalcitonin are high in the blood. A rapid HIV test was positive confirmed by serology.

The chest X-ray and the chest CT scan revealed signs in favor of pneumocystosis, as well as the presence of a diffuse anterior pneumomediastinum. Given the hypoxia, we were unable to perform the bronchoscopy.

The evolution was marked by the constitution of a subcutaneous emphysema spreading quite quickly in the cervical and anterior thoracic regions.

The non-resolution spontaneously and under oxygen motivated the team to perform an iatrogenic pneumothorax and to connect the chest drain to a gentle suction system.

After 1 month of continuous aspiration and treatment of the pneumocystosis as well as the HIV virus infection, a chest CT scan was performed which showed complete resolution of the pneumomediastinum.

The drain was removed and the patient was discharged unnecessarily on oxygen.

Pneumomediastinum remains a rare clinical manifestation. This condition can be spontaneous or secondary to trauma or airway pathology.

The aim of this work is to reveal a fairly rare form of pneumomediastinum secondary to pneumocystosis, and to demonstrate the need sometimes to treat subcutaneous emphysema with an induced pneumothorax.

Keywords: Pneumomediastinum; Aspiration; Pneumothorax

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