A 12-month-old woman presented with persistent crying, poor cough and respiratory distress for about 10 hours.
The patient had two vomiting, partial rejection of feeding and rhinorrhea.
His personal history included three previous episodes of bronchospasm.
As a family history to highlight, the mother suffered from asthma.
Clinical examination revealed: weight 8.1 kg (P3), height 72 cm (P25), temperature 37.4o C, blood pressure 101/85 mm Hg, heart rate 148 bpm 68 bpm.
She had a good general appearance, was irritable and did not calm down in her mother's arms.
She presented with intercuspal and intercostal respiration.
Respiratory auscultation revealed a good airway with bilateral wheezing and enlarged ejection fraction.
Cardiac auscultation was normal.
The oropharynx was hyperemic, with abundant mucus in cavum.
Otoscopy revealed bilateral tympanic hyperemia with preserved luminous reflex.
The rest of the examination was normal.
Anteroposterior and lateral chest X-rays showed signs of air attraction with presence of anterocardiac air, continuous diaphragm and minimal subcutaneous emphysema in the neck.
This led to the diagnosis of pneumomediastinum associated with bronchospasm and was admitted to the hospital.
Oxygen treatment was administered through nasal glasses as needed, inhaled salbutamol and prednisolone orally.
The clinical course was good, on the third day there were no signs or symptoms of respiratory distress, and the control chest X-ray showed a decrease in the size of the air in the mediastinum, so he was discharged.
The sweat chloride test was normal.
