Pneumorrhachis is the presence of air within the spinal canal and is most often traumatic or iatrogenic in etiology. Rarely, small amount of pneumorrhachis can be seen with spontaneous pneumomediastinum. Here we describe a case of asymptomatic longitudinally extensive pneumorrhachis associated with spontaneous pneumomediastinum.
A man in his mid-20s presented to the hospital with subcutaneous emphysema after a choking episode. On imaging of his neck and chest he was noted to have extensive pneumorrhachis with anterior displacement of the spinal cord. Out of concern for further accumulation of air he was monitored in an intensive care setting for 48 hours but remained asymptomatic. He was discharged home after ruling out esophageal rupture as a cause for his pneumomediastinum. On follow up one month after discharge he was doing well without symptoms.
In cases of spontaneous pneumomediastinum, air can be entrained within the spinal canal. Special attention should be paid to any patient with pneumomediastinum with neurological symptoms, as this could be due to pneumorrhachis.

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