We present a case of a 16-year-old girl presenting with spontaneous pneumomediastinum, leading to the diagnosis of anorexia nervosa (restrictive subtype) with extreme malnutrition necessitating refeeding.

A 16 year old female of Korean background presented to the emergency department with sudden onset left-sided chest pain, palpitations and shortness of breath. The patient reported left-sided dull parasternal chest pain, radiating to the left jaw and neck, exacerbated by deep inspiration, leaning forwards or lying supine. There was no reported trauma, coughing or vomiting. The patient reported 10kg of weight loss over the past 12 months, attributed to restrictive eating secondary to study-related stress. She also reported amenorrhoea for 9 months. She denies...

Spontaneous pneumomediastinum is a rare but life-threatening complication of anorexia nervosa and is often caused due to vomiting[1,2]. Although less common, there are cases reported which are not associated with vomiting[3,4]. This is postulated to be due to more fragile alveolar walls in malnourished anorexia nervosa patients[4,5,6]. Animal studies have shown that malnutrition and calorie restriction results in thinner alveolar walls and reduced number of alveoli[6]. Human post-mortem studies of Jewish victims of the Warsaw Ghetto, suffering from chronic starvation also found large alveoli and...

Individuals with anorexia nervosa have an increased risk of spontaneous pneumomediastinum. Anorexia nervosa should be considered, both with and without vomiting, as a potential cause of spontaneous pneumomediastinum. From a radiology perspective, it is important to identify the presence of pneumomediastinum, particularly in the setting of anorexia nervosa, as its presence could indicate a malnourished state at the time of imaging. This is significant as in comparison to non-anorexic counterparts, pneumomediastinum may take substantially longer (up to 2 months) to resolve[6,10].

L. Burgess: Nothing to disclose

Brant WE, Helms CA. Fundamentals of diagnostic radiology. 5th ed. USA: Lippincott Williams & Wilkins; 2018 Gorrochategui M, Weerakkody Y, Chieng R, et al. Radiopaedia [homepage on the Internet]. Radiopaedia.org; [updated 2023 March 8; cited 2023 April 1]. Pneumomediastinum. Available from: https://radiopaedia.org/articles/4653 Kraeft JJ, Uppot RN, Heffess AM. Imaging findings in eating disorders. American journal of roentgenology. 2013 April;200(4):W328-W335. Cheong L, Koh ES, Teo DB. Pay air-tension: anorexia and tension pneumomediastinum. The American journal of medicine. 2019 Nov;132(11):1292-1294 Hochlehnert A, Löwe B, Bludau HB, Borst...