Spontaneous Pneumomediastinum as a Rare Presentation of Diabetes: A Case Report

Abstract

Spontaneous pneumomediastinum is a rare condition characterized by the presence of air in the mediastinum in the absence of any traumatic or iatrogenic cause, typically occurring in healthy, non-pathological lungs. Vomiting is described as a triggering factor, with sudden intra-bronchial hyperpressure due to Valsalva maneuvers being the most commonly reported hypothesis. This case report describes an atypical complication of diabetic ketoacidosis, revealing previously undiagnosed diabetes through spontaneous pneumomediastinum as the mode of presentation. A young patient with a history of cocaine use presented with intractable vomiting and severe epigastric pain. Upon admission, the patient had tachypnea, dyspnoea, and tachycardia. A CT scan revealed interstitial emphysema with pneumomediastinum, pneumorrhachis, and subcutaneous emphysema. The patient was managed conservatively, with fluid replacement, insulin therapy, resulting in a significant improvement in his condition.