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Images in Thorax
Teenager with chest pain and swollen neck: a leave-it-alone condition
  1. Pen-Yuan Liao1,2,3,
  2. Hung-Jung Wang3
  1. 1Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
  2. 2Imaging Research Center, Taipei Medical University, Taipei, Taiwan
  3. 3Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan
  1. Correspondence to Dr Pen-Yuan Liao, Department of Emergency Medicine and Department of Medical Imaging, Taipei Medical University Hospital, 252 Wu-Shing Street, Taipei 110, Taiwan; pyliao100{at}


A 19-year-old boy with shortness of breath and chest pain after strenuous exercise presented to emergency department . On physical examination, the neck and shoulders appeared to be swollen. There was crepitus on skin palpation. Chest X-ray disclosed diffuse subcutaneous emphysema and pneumomediastinum. CT showed additional finding of air in epidural space. The patient was discharged after 2 days of hospitalisation with conservative treatment uneventfully. Pneumorrhachis is usually caused by abrupt increase in intrathoracic pressure in instance of forceful vomiting, cough or asthma attack in an otherwise healthy young adult. It is usually accompanied with pneumomediastinum. The management of epidural pneumatosis should be tailored according to its primary cause. For most patients with pneumorrhachis associated to a spontaneous pneumomediastinum without neurological symptoms, this condition is generally self-limited. For epidural free air of large volume that causes neurological deficits, surgical laminectomy may be indicated.

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