• Faisal Al-Mufarrej, Farid Gharagozloo, Barbara Tempesta, and Marc Margolis.
• Department of Surgery, Division of Cardio-Thoracic Surgery, The George Washington University Medical Center, Washington, DC 20037, USA. faisal@gwu.edu
• Clin Respir J. 2009 Oct 1;3(4):239-43.

IntroductionPneumorrhachis, or epidural pneumatosis, is a rare entity that is usually traumatic or iatrogenic. Usually, the epidural emphysema is limited to a few vertebral spaces. Less commonly, it is secondary to mediastinal air that tracks into the epidural space. Mediastinal air is usually associated with subcutaneous emphysema, but rarely is it associated with pneumopericardium or pneumoperitoneum. The cause of pneumomediastinum is usually identifiable on history or radiology.MethodsReport of a case.ResultsWe report the extremely rare simultaneous occurrence of self-limiting cervicothoracolumbar pneumorrhachis, pneumomediastinum, cervical subcutaneous emphysema and pneumoperitoneum in a healthy 20-year-old gentleman in the absence of an identifiable cause.ConclusionExtensive pneumorrhachis and pneumoperitoneum may simultaneously accompany pneumomediastinum and subcutaneous emphysema in the absence of an identifiable cause and still follow a benign clinical course.

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