A 15-year-old boy in Tokyo finished a choir class with a pain in the front of his chest that would not let up. It got worse every time he breathed in. He was not coughing. He was not short of breath. He had not vomited. His vital signs were normal, his breath sounds were normal, and nothing about his chest wall looked wrong on examination.
By the time doctors finished imaging him, they had found air where air is not supposed to be: inside the mediastinum, the compartment in the middle of the chest that holds the heart, the great vessels, and the esophagus. Some of it had also tracked up into the soft tissue of his neck.
