Background:

Spontaneous pneumomediastinum is the presence of free air in the mediastinum that does not occur from direct thoracic or esophageal trauma. It is a very rare condition usually related to patients with asthma, respiratory infections, or foreign body aspiration. Only a few cases are reported to be associated with severe reflux events.

Case report:

We present the case of a 10-year-old female with spontaneous pneumomediastinum extending to the neck secondary to severe and persistent hiccups, with no history of asthma, trauma, surgery, acute infection, foreign body aspiration, and intense exercise with Vasalva.

Conclusions:

The irritation of the distal third of the esophagus produced severe and persistent episodes of hiccups that increased the intrathoracic pressure, which in turn triggered the pneumomediastinum by Macklin effect. The diagnosis is made with imaging studies. The treatment is conservative with resolution of the clinical picture between five and seven days after hospitalization.