In Reply.—
Zwerdling and Hen correctly point out the well-known association of pneumomediastinum and asthma. In most patients, pneumomediastinum occurs as a complication of asthma; in fact, a child reported by Knott in 1850 had been wheezing for 3 weeks!
My paper was intended to emphasize that severe anterior chest pain, precordial crunching, and the presence of subcutaneous air in the neck of a previously healthy adolescent should lead to the clinical diagnosis of spontaneous mediastinal emphysema. Thus, on clinical grounds alone, one can rapidly identify a benign illness in a seemingly critically ill patient.
Surgical and mediastinal emphysema in critically ill COVID-19 patients: A multicentric experience
