Spontaneous pneumomediastinum and subcutaneous emphysema during acute exacerbation of idiopathic pulmonary fibrosis: a case report

Spontaneous pneumomediastinum and subcutaneous emphysema are uncommon complications of idiopathic pulmonary fibrosis (IPF). We report the case of a 74-year-old man with advanced IPF and long-term oxygen dependence who was hospitalised because of acute exacerbation of IPF. During hospitalisation, he developed acute chest discomfort, cervical swelling, and facial swelling. Physical examination revealed subcutaneous crepitus, and high-resolution computed tomography (HRCT) confirmed pneumomediastinum and extensive subcutaneous emphysema without pneumothorax or CT findings suggestive of oesophageal perforation. The patient remained haemodynamically stable and was managed conservatively with supplemental oxygen, analgesia, and close clinical monitoring. Positive-pressure ventilation was not clinically required and was avoided because of its potential to aggravate the existing air leak. Follow-up computed tomography demonstrated marked regression of pneumomediastinum and complete resolution of subcutaneous emphysema after two weeks. This case highlights that clinically significant pneumomediastinum may complicate acute exacerbation of IPF even in the absence of trauma, invasive procedures, or positive-pressure ventilation. Early recognition, HRCT confirmation, exclusion of secondary causes, and individualised management may result in favourable outcomes in selected patients.