Silent Pneumomediastinum after salmon ingestion- An Unusual
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A 21 - year old young man presented with complaints of difficulty in swallowing 4 h after he had ingested a salmon. On examination revealed body temperature of 36.8 degrees, heart rate 86 bpm, respiratory rate 18 bpm, and blood pressure 116/75 mm Hg. Results of laboratory examinations were unremarkable. Indirect laryngeal examination showed normal, no pooling of saliva. Soft tissue neck lateral view radiography revealed air tracking to mediastinum and no evidence of foreign body.

Computed tomography (CT) of neck confirmed no evidence of foreign body and the hyper dense concentric wall thickening of the upper esophageal lumen was suggestive of a perforation of the esophagus with intramural hematoma at the level of thoracic inlet. Pneumomediastinum was seen surrounding the trachea, esophagus, bilateral hilar region extending superiorly in to the neck, posterior to the right common carotid artery and inferiorly up to and surrounding the distal esophagus. There was also pronounced pneumomediastinum around the level of aortic arch and below the thoracic duct. The patient had only difficulty in swallowing without any signs of pneumomediastinum.

The patient was kept nil per oral and had nasogastric tube placed to clear gastric contents and limit further contamination. Broad spectrum intravenous antibiotics were instituted for five days along with intravenous fluids and narcotic analgesia. After conservative medical management the patient recovered completely and was subsequently discharged home.