Conclusions

Our case highlights an unusual presentation of spontaneous pneumomediastinum in an elderly patient without identifiable precipitating factors, associated with rapidly progressive, extensive subcutaneous emphysema requiring intervention. Although spontaneous pneumomediastinum is a rare condition that commonly affects young males and is usually benign and self-limiting, it can occasionally present atypically with extensive subcutaneous emphysema, requiring close monitoring and timely management.

Hence, spontaneous pneumomediastinum is an important differential diagnosis that should be considered in patients presenting with acute chest symptoms and subcutaneous emphysema. Prompt diagnosis and appropriate management are essential to prevent complications and ensure favorable clinical outcomes.