Pneumomediastinum and subcutaneous emphysema from bronchial foreign body aspiration

Pneumomediastinum and subcutaneous emphysema are rare presentations of an airway foreign body. Only a handful of other cases have been reported in the English literature. We present a case of a 2 year old female who presented with wheezing and a dry cough. Following a breathing treatment with a non-rebreather mask, she developed right sided facial subcutaneous emphysema. The following day, after an episode of crying, the subcutaneous emphysema rapidly progressed to involve the anterior chest wall, shoulders, neck and face. Rigid bronchoscopy was emergently performed and a ball-valving, soft foreign body was removed from the right bronchus. A chest tube was placed, and the patient was successfully extubated the following day. When faced with a pediatric patient presenting with subcutaneous emphysema or pneumomediastinum of unknown origin, the pediatrician and otolaryngologist should consider the possibility of an airway foreign body. Management involves emergent airway evaluation in the operating room, removal of the foreign body, placement of a chest tube if pneumomediastinum is present, and supportive care with reflux medications and intravenous steroids.