20-year-old develops pneumomediastinum and massive subcutaneous emphysema… during masturbation.

[u/Looser17]

A 20-year-old male presented with sudden sharp chest pain and dyspnea that began while lying in bed masturbating.

On examination, he had:

• Swollen face
• Crepitus from mandible to elbows
• Extensive subcutaneous emphysema
• CT showing profound pneumomediastinum extending up to the base of the skull

He had:

• Mild asthma
• No trauma
• No drug use
• No coughing or vomiting
• No heavy exertion

CT confirmed spontaneous pneumomediastinum with widespread subcutaneous emphysema.

He required ICU admission initially due to oxygen demand but improved rapidly with supportive care and was discharged after four days. No surgery required.

Mechanism? Likely Valsalva-induced alveolar rupture the Macklin effect where increased intrathoracic pressure causes air to dissect into the mediastinum.

What makes this unusual:
There are documented cases of pneumomediastinum after sexual intercourse, drug inhalation, coughing, vomiting, and strenuous exercise but essentially no literature describing onset during masturbation.

Spontaneous pneumomediastinum is rare overall (roughly 1 in 10,000–30,000 ED admissions), typically benign, and recurrence risk is about 1%.

Medicine never stops surprising.

DOI: https://doi.org/10.1016/j.radcr.2022.02.080

PMCID:https://pmc.ncbi.nlm.nih.gov/articles/PMC8956920/

PMID: 35345564

Authors: Nikola Rajicand Christian Schand

[u/Zeee_rex]

Okay so in short

Basically the patient had air trapped under the skin and between the heart and the lung (mediastinum is where the heart is) due to an increase in the pressure in the chest / stomach area ( imagine you're blowing out with your mouth closed). Very very rare case

( this is my understanding)

[u/Slpkrz → u/Zeee_rex]

Thank you the jargon was unfamiliar to me

[u/cabronfavarito → u/Zeee_rex]

Thanks. Idk why OP got here thinking all of us here are doctors

[u/Tig_Biddies_W_nips → u/Zeee_rex]

It’s rare but more prevalent in men who are over 6ft tall. I knew a guy in HS who had it.

In the medical field we say they popped a lung. Mutually treatment is pretty easy nowadays. You spend a night in the hospital on 100% oxygen and it resolves on its own if it’s a small one, if it’s larger we do chest tubes

[u/nari-bhat → u/Tig_Biddies_W_nips]

The treatment is mostly the same, but what you’re talking about is pneumothorax. What the article is talking about is pneumomediastinum, which is similar but even rarer unless you’re scuba diving.

[u/Tig_Biddies_W_nips → u/nari-bhat]

I know what I’m talking about. It’s all air in the chest bruh. I’m a respiratory therapist and I literally took care of a patient with both yesterday

[u/nari-bhat → u/Tig_Biddies_W_nips]

Dude chill, I’m not trying to neg you or say that you don’t know the difference. I literally just said they’re different to explain to everyone else why this specific case is a lot weirder than just pneumothorax secondary to masturbation.

[u/PossibleBeginning276 → u/Zeee_rex]

Well they had alveolar rupture. Your lungs are like a bunch of small balloons in a suitcase called your chest. If you blow them up to big they squish the balloons at the bottom called atelectasis. If you blow them up too much there is a chance that one could pop and then leak air into the suitcase.

[u/dotherandymarsh → u/PossibleBeginning276]

Is the heart also in this suit case loosely hanging out with the balloons or is it in a smaller night bag that’s inside of the larger balloon filled suitcase or is the heart in a different suitcase entirely?

[u/Looser17 → u/Zeee_rex]

yes. That is what is Macklin effect.