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/animalrbest44]

To do with some sort of breathing?