Image challenge: acute chest pain after tooth extraction

Clinical introduction

A previously healthy 55-year-old woman presented to the ED with chest discomfort. She underwent wisdom tooth extraction the same morning, during which she experienced discomfort over the right side of neck, which gradually spread to the right and central chest region, and was associated with discomfort while breathing. On examination, there was tenderness over the neck and chest. Range of motion of the neck was limited due to pain. Her vitals were stable, and the rest of the physical examination was unremarkable.

A frontal chest radiograph was obtained (figure 1).

Question

What is the most likely diagnosis for this patient?

Spontaneous pneumothorax

Spontaneous pneumomediastinum

Spontaneous pneumopericardium

Foreign body in respiratory tract

Answer: B

The chest radiograph of this patient shows pneumomediastinum and soft tissue emphysema in the neck (figure 2). Pneumomediastinum is the presence of air within...

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