Case 9 Answer

Answer: Pneumomediastinum

Although the causes a numerous, this patient had a short episode of upper chest pain and then felt fine. Even upon exam there was little to be found. Expected etiology in this cause is spontaneous rupture of a small bleb allowing air to track back into the mediastinum. This is actually more common than you would think. We see these not that infrequently. Although ER/surgery usually wants the esophagram to rule out an esophageal injury, often there is no history to suggest GI injury and without ANY pleural fluid, this seems unlikely. But you’ll end up doing the esophagram anyway.