D. Pneumomediastinum / Pneumorachis
This patient suffered from pneumomediastinum complicated by pneumorachis secondary to persistent coughing. Pneumorachis, or air in the spinal canal, is a rare complication of pneumomediastinum. Pneumomediastinum can be either spontaneous or traumatic in origin. In pediatric patients, pneumomediastinum is most often associated with asthma and bronchiolitis. Spontaneous pneumomediastinum is most common in tall, thin adolescent males and newborn infants, though it can. be seen in toddlers and other ages as well. Her esophagram was normal and the history was not significant for emesis making Boerhaave syndrome (effort rupture of the esophagus) unlikely. Less than 20 cases of tension pneumomediastinum have been reported, and this patient did not have tension pneumothorax physiology. Treatment consists of analgesia, rest, avoidance of Valsalva maneuver, incentive spirometry, and in moderate to severe cases of pneumomediastinum high-partial pressure oxygen therapy.
This patient was initially admitted to the PICU on a non-rebreather mask, but was later transitioned to nasal cannula and ultimately room air. Anti-tussive medications were initiated in addition to Amoxicillin for treatment of strep pharyngitis. She did well and was discharged home on hospital day #6.