Unusual presentation of spontaneous pneumomediastinum

Spontaneous pneumomediastinum (SPM) is an uncommon, self-limiting condition resulting from alveolar rupture in young adults. There are asthma, illicit drug use, and activities triggering a Valsalva maneuver as causes of developing SPM. We report two patients who were diagnosed with SPM in the absence of known predisposing factors and without any clinical sign of subcutaneous emphysema of the neck, the most common physical finding on presentation. Both of them developed dysphagia after swallowing a peach seed and boned rib of pork, respectively. SPM was suspected after performing lateral neck X-ray, and the diagnosis of SPM was confirmed by chest CT. These cases showed the importance of performing the lateral neck X-ray to screen SPM in patients with dysphagia.