A Toddler with Spontaneous Pneumomediastinum

CASE PRESENTATIONAn 18-month-old female with unremarkable birth history presented to the emergency department (ED) for drooling and "difficulty breathing."She had three days of cough and rhinorrhea, but otherwise no reports of fever, vomiting, trauma, foreign-body ingestion or aspiration.Her vaccinations were up to date.Her vital signs included blood pressure 143/98 mmHg, pulse 135 beats per minute, respiration 20 breaths per minute, temperature 36.ºC, oxygen saturation 98% on room air.Her examination was remarkable for pooled oral secretions and preferential rightwards neck tilt.She was without stridor or wheezing.She had no neck masses, tongue swelling, or crepitus.She was initially started on broad-spectrum antibiotics.A lateral neck and chest radiograph revealed retropharyngeal and subcutaneous emphysema tracking inferiorly into the mediastinum (Image 1).Bedside nasal endoscopy showed a patent airway and no masses.A computed tomography (CT) of the neck and chest (Image 2) and esophagram were otherwise unremarkable.

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