Class test stress as an unusual cause of spontaneous pneumomediastinum in a 14-year-old girl.

Pneumomediastinum can occur spontaneously in several medical conditions such as asthma or secondarily because of injuries of the trachea or esophagus. Both types of pneumomediastinum may be life threatening, depending on possible complications and, additionally, in the secondary pneumomediastinum, because of an underlying condition. This is the case of a 14-year-old girl who experienced a pneumomediastinum after snorting during a class test owing to psychologic stress. Because of the lack of a specific history, complete radiologic diagnostic was done to exclude any life-threatening cause of pneumomediastinum. Only then did questioning reveal anger during the class test that caused a short snorting. The case demonstrates that psychologic stress may cause pathologic patterns of breathing and thereby induce pneumomediastinum. Thus, history has to include the question on psychologic stress.