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Eur J Cardiothorac Surg 2005;28:502-503
© 2005 Elsevier Science NL

Case report

Tension pneumomediastinum after severe vomiting in a 21-year-old female

Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria

Received 14 April 2005; received in revised form 29 April 2005; accepted 2 May 2005.

^* Corresponding author. Tel.: +43 316 385 3302; fax: +43 316 385 4679. (Email: sabine.gabor{at}meduni-graz.at).

A 21-year-old female with chronic membranoproliferative nephritis was admitted for suspected esophageal disruption and asthma after severe, prolonged vomiting. At the time of admission she presented with dyspnea, tachypnea, arterial hypotension and tachycardia. Physical examination showed discrete signs of ectopic air at the neck and distended cervical veins. CT-scan of the chest showed severe mediastinal emphysema with compression of the right atrium. After cervical mediastinotomy the cardiorespiratory parameters normalized immediately. Esophagoscopy showed multiple longitudinal mucosal tears between 25 and 45cm; fluoroscopically, there was no leakage of contrast medium. Following conservative treatment the patient recovered completely and was discharged on day 8.

Key Words: Tension pneumomediastinum • Esophagus • Mucosal tear

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