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A 15-year-old boy had the sudden onset of sharp, piercing, centralized chest pain while at rest. He had no important medical history. He also reported a sore throat and said there had been no history of trauma. The results of a physical examination, routine complete blood count, and serum biochemistry profiles were unremarkable. The chest radiograph (Panel A) showed clear lungs, pneumomediastinum (arrows), and pneumopericardium without evidence of rib fracture or pneumothorax. Computed tomography of the chest (Panels B and C) showed subcutaneous emphysema of the neck, pneumomediastinum (arrows), and pneumopericardium. An upper gastrointestinal series revealed no leakage of contrast medium. Spontaneous pneumomediastinum was diagnosed. The patient received treatment with analgesics and oxygen therapy and was discharged after three days. A follow-up chest radiograph demonstrated complete resolution of the pneumomediastinum. He has had no recurrences and continues to do well.
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