An Interesting Presentation of Pneumomediastinum Secondary to Hyperemesis Gravidarum in the Second Trimester

We present a rare case of pneumomediastinum in the setting of hyperemesis gravidarum. Pneumomediastinum is a condition characterized by the presence of air leaking into the mediastinum. Often secondary to trauma, there remains the potential for it to develop spontaneously. This is a time-sensitive diagnosis that requires vigilance for effective treatment. A 21-year-old gravida 1 para 0 female at 15 weeks of gestation with no significant past medical history presented to the emergency department complaining of four weeks of daily nausea and vomiting and two weeks of chest pain, cough, and difficulty breathing. Computed tomography angiography of the chest revealed the presence of subcutaneous air in the mediastinum, and esophageal rupture was ruled out by a gastrografin esophagram. Due to extensive pneumomediastinum and severe metabolic derangements, the patient was admitted to the intensive care unit. A gastrografin esophagram was obtained, which showed no esophageal tear. No surgical intervention was performed, and she was managed with conservative treatment. This case illustrates some of the severe complications of pregnancy. Although pneumomediastinum secondary to hyperemesis gravidarum seen in this patient is rare (the incidence of pregnancy-related pneumomediastinum has been noted to be 1:100,000), it is an important adverse complication that the clinician should keep in mind in pregnant patients with hyperemesis gravidarum. Providing education to patients during the prenatal process can help identify the signs and symptoms of this condition to prevent potentially fatal consequences.