Pneumomediastinum and vomiting: Which approach to diagnosis? A case report

Background - Spontaneous pneumomediastinum (SPM) is a rare and often unrecognized condition of which vomiting is one of the reported triggering factors. Differentiating SPM fromBoerhaave's syndrome (pneumomediastinum secondary to esophageal breach) is the first stepin management and prognosis. Observation. - A 27-year-old woman with systemic lupus erythematous presented to the emergency department with epigastralgia, incoercible vomiting and diarrhoea. Abdominal CT showedcircumferential thickening of the duodenum and bilateral ureteritis. Chest sections showedpneumomediastinum extending to the cervical region. Therapeutic management was based onprophylactic antibiotic therapy and an absolute diet (fasting). A CT scan with upper gastrointestinal opacification was performed to prevent esophageal rupture and showed quasi-obstructivethickening of the antral mucosa. The diagnosis was lupus enteritis and pneumomediastinum wassecondary to the vomiting efforts. The patient was placed on corticosteroids and a favorableoutcome ensued. Conclusion. - Strenuous vomiting is one of the precipitating factors of SPM. Boerhaave's syndrome is the main differential diagnosis with a poor prognosis, unlike SPM, which has a goodprognosis with conservative treatment. (c) 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.