Diabetic Ketoacidosis with Spontaneous Pneumomediastinum: A Case Report

Sung Ho Shin; Doo Man Kim; Ju Ri Park; So Yon Rhee; Jae Sung Ahn; Han Min Park; In Young Park

doi:10.4093/jkd.2015.16.2.148

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Shin, Kim, Park, Rhee, Ahn, Park, and Park: Diabetic Ketoacidosis with Spontaneous Pneumomediastinum: A Case Report

Case Report

J Korean Diabetes 2015;16(2):148-152.

Published online: 20 January 2015

DOI: https://doi.org/10.4093/jkd.2015.16.2.148

Diabetic Ketoacidosis with Spontaneous Pneumomediastinum: A Case Report

Sung Ho Shin, Doo Man Kim, Ju Ri Park, So Yon Rhee, Jae Sung Ahn, Han Min Park, In Young Park

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

Corresponding author: Doo Man Kim Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150 Seongan-ro, Gangdong-gu, Seoul 134-701, Korea, E-mail: dmjmsy@hanmail.net

Received 28 August 2014 Revised 25 September 2014 Accepted 26 September 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Spontaneous pneumomediastinum (SPM) is defined as the presence of extraluminal gas in the mediastinal space without any clear traumatic cause. It has been reported in association with asthma exacerbation, emesis, childbirth, seizure, excessive shouting, drug inhalation and diabetic ketoacidosis (DKA). SPM complicated by DKA is infrequently accompanied with chest pain and DKA can lead to changes in respiratory rate and depth; this complication might be underestimated. Here, we report a 21-year-old male with throat pain on swallowing due to SPM complicated by DKA. Clinicians need to consider this complication in differential diagnoses.

Keywords: Diabetic ketoacidosis, Diagnostic, Mediastinal emphysema, Pneumomediastinum

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Fig. 1.

(A) Postero-anterior view and (B) left-lateral view chest radiograph. (A) The radiolucent lines beside the aorta indicate the mediastinal emphysema (arrows). (B) The presence of air dissecting the posterior cardiac border and mediastinal structures is demonstrated by left-lateral view (arrows).

Fig. 2.

Neck and chest computed tomography. (A, B) Diffuse air density lesions from nasopharynx to mediastinum and (C) soft tissue emphysema were seen (arrows).

Fig. 3.

Esophagography. (A) Cervical portion, (B) thoracic portion, (C) abdominal portion. No demonstrable leakage of contrast media into the soft tissue space.

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