Differential Diagnosis for Pneumomediastinum in a Healthy 22-Year-Old Female 14 Weeks Pregnant

• Single Most Likely Diagnosis
  • Spontaneous pneumomediastinum: This condition is more common in young, healthy individuals, especially during pregnancy due to increased lung volumes and alveolar rupture. The hormonal changes during pregnancy can also lead to relaxation of the bronchial and alveolar walls, making them more susceptible to rupture.
• Other Likely Diagnoses
  • Asthma or chronic obstructive pulmonary disease (COPD) exacerbation: Although the patient is described as healthy, undiagnosed or mild asthma could lead to pneumomediastinum, especially if the patient has had recent respiratory symptoms.
  • Intrapartum or pregnancy-related complications (e.g., uterine rupture, placental abruption): While less common, these conditions can lead to pneumomediastinum due to increased intrathoracic pressure or direct injury to the lungs or airways.
• Do Not Miss Diagnoses
  • Pulmonary embolism: Although less likely in a healthy young pregnant woman, pulmonary embolism can cause pneumomediastinum and is a potentially life-threatening condition that requires immediate attention.
  • Aortic dissection or rupture: This is a rare but catastrophic condition that can cause pneumomediastinum and requires prompt diagnosis and treatment.
  • Esophageal rupture or perforation: This condition can lead to pneumomediastinum and is a medical emergency that requires immediate surgical intervention.
• Rare Diagnoses
  • Lymphangioleiomyomatosis (LAM): A rare lung disease that can cause pneumomediastinum, especially in young women.
  • Cystic fibrosis: Although typically diagnosed in childhood, some cases may not be diagnosed until adulthood, and pneumomediastinum can be a complication of the disease.
  • Connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome): These conditions can increase the risk of pneumomediastinum due to weakened connective tissue in the lungs and airways.