Introduction:

Pneumomediastinum (NM) is the most frequent manifestation of air leak syndrome in asthmatic crisis in adults. Its course is benign despite sometimes could occur complications like pneumothorax and pneumopericardium. However NM can be subdiagnosticated if it is not suspected. Cases presentation: Both cases was development in Bogota (2,640 m.a.s.l.) Case 1: A 30 years old female who had moderate persistent asthma since childhood and smoke habit presents with a history of cough, breathlessness, chest and cervical pain. On examination, she has hypoxemia, wheezing and cervical subcutaneous emphysema, the latter confirmed by chest x-ray. Chest computed tomography (CT) demonstrated extensive NM. Case 2: A 16 years old teenage women with a history of asthma since she was 8 years old was evaluated for acute respiratory symptoms, breathlessness and chest pain. On physical examination she has oxygen desaturation on room air, cervical and thoracic subcutaneous emphysema and generalized wheezing. Chest x-ray confirmed cervical subcutaneous emphysema and chest CT diagnosed NM. Neither of the cases had pneumothorax or hemodynamic compromise. Both cases had satisfactory evolution with bronchodilators, systemic corticoid, oxygen suplency an repose.

Conclusions:

Up to 11% of asthmatic crisis can course with NM. Clinical clues include no improvement of the hypoxemia in first 24 hours, chest and cervical pain and subcutaneous emphysema. Chest CT is the diagnostic tool of choice. NM usually follows a benign course although can has life-threatening complications. Management consists in treatment of bronchial obstruction, high fraction of inspired oxygen oxygenotherapie and repose.