A 19-year-old woman arrived at a Turkish emergency department with sudden, stabbing chest pain that had started while she was shouting for her team at a soccer match. Her electrocardiogram was normal. Her troponin and lactate were within the reference range. Her chest X-ray showed nothing. Two hours later, as staff prepared her discharge paperwork, a doctor examining her neck felt a fine crackling under the skin, like crushed bubble wrap.
A repeat X-ray and a CT scan found what the first round of tests had missed. Air had escaped from her lungs and collected in the mediastinum, the central compartment of the chest that houses the heart, the esophagus, and the great vessels. She had spontaneous pneumomediastinum, and the trigger was nothing more exotic than cheering.
