• Michael R Ehmann, Karolina Paziana, and Andrew I Stolbach.
• Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland.
• J Emerg Med. 2016 Feb 1; 50 (2): e43-5.

BackgroundPneumorrhachis (PR) describes the clinical finding of air within the spinal canal and rarely has been associated with spontaneous pneumomediastinum. There is little medical literature addressing the evaluation and management of these patients in the emergency department.Case ReportWe present a series of patients with PR secondary to a spontaneous pneumomediastinum and briefly review the available literature on the topic to discuss reasonable management strategies for patients presenting with this rare finding. In both cases, the patients had excellent outcomes with expectant management despite the worrisome finding of air in the spinal canal. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must be able to promptly recognize and appropriately assess even uncommon pathology. As with other rare conditions, there are no published guidelines for the ED management of PR, necessitating the use of case presentations to educate providers as to the complications and plan of care of this diagnosis.Copyright © 2016 Elsevier Inc. All rights reserved.

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