Spontaneous pneumomediastinum secondary to hyperemesis gravidarum: A case report and principles of recognition and management

Pneumomediastinum is the presence of aberrant air in the mediastinum and is most commonly caused by oesophageal or alveolar rupture. Hyperemesis gravidarum is persistent nausea and vomiting before the 20th week of pregnancy and can increase intra-thoracic pressure, precipitating pneumomediastinum. A 22-year-old patient presented with hyperemesis gravidarum in the 6th week of pregnancy. During her hospital admission, she developed chest pain, and imaging showed pneumomediastinum. Endoscopy excluded oesophageal perforation, a diagnosis of spontaneous pneumomediastinum was made, and her symptoms improved with conservative management. This case demonstrates how oesophageal perforation and spontaneous mediastinum can present in similar fashion. Oesophageal perforation has high morbidity and mortality and it is vital to identify it early. It is therefore important that clinicians are aware of pneumomediastinum as a potential complication of hyperemesis gravidarum and exclude oesophageal perforation in these individuals. •Pneumomediastinum is a rare complication of Hyperemesis Gravidarum.•The first priority of management of pneumomediastinum in pregnancy is to rule out oesophageal rupture•Once oesophageal rupture has been excluded, management for spontaneous pneumomediastinum can commence.•Spontaneous pneumomediastinum can often be treated conservatively.