Abstract

Spontaneous pneumomediastinum (SPM), also known as Hamman’s syndrome, is characterized by the presence of free air in the mediastinum without an identifiable etiology such as trauma, iatrogenic injury, or infection caused by gas-producing microorganisms. Pneumorrhachis (PR), defined as the presence of intraspinal air, is an extremely rare complication of SPM and is usually asymptomatic. The coexistence of SPM and PR has been very rarely reported in the pediatric population. A 16-year-old male patient presented to the emergency department with chest pain, shortness of breath, and cough persisting for two days. Physical examination revealed extensive subcutaneous emphysema extending to the neck, chest, and upper abdominal region, along with bilateral inspiratory wheezing. Laboratory evaluation showed a white blood cell count of 16,200/mm³, neutrophilia (11,000/mm³), and elevated C-reactive protein (25 mg/L). A chest radiograph and noncontrast thoracocervical computed tomography demonstrated pneumomediastinum and air within the epidural space, consistent with PR. Infectious disease evaluation, including a viral panel, was negative. No acute neurosurgical pathology was detected. The patient was managed conservatively with oxygen therapy, antibiotics, and close monitoring. An esophagogram performed on the second day showed no evidence of perforation. The patient was discharged in good condition on the eighth day, and no recurrence was observed during 18 months of follow-up. Pneumorrhachis associated with SPM is a rare but benign clinical entity in adolescents. In the absence of neurological symptoms and complications, conservative treatment is sufficient. Our case demonstrates that the coexistence of SPM and PR in pediatric patients can be safely managed without invasive interventions and highlights the importance of imaging modalities in early and accurate diagnosis.

Citation: Arabul Aydogdu S, Gurel D, Yakut E. Spontaneous pneumomediastinum and pneumorrhachis in an adolescent: Benign but alarming. Turkish J Ped Surg 2026;40(3):181-185. doi: 10.62114/JTAPS.2026.185.

This study was presented at the 42nd National Congress of Pediatric Surgery, held on 2-5 October 2025 in the Turkish Republic of Northern Cyprus.