Abstract
Spontaneous pneumomediastinum, also called Hamman's syndrome, is an uncommon condition that results from alveolar rupture with air tracking into the mediastinum. It is usually triggered by events that raise intrathoracic pressure, but because of its rarity, it is often overlooked and may initially be confused with more serious conditions. The prognosis is generally excellent, as most cases resolve without intervention. We describe the case of a woman in her early 20s, with a history of regular e-cigarette use, who developed acute chest pain, shortness of breath, vomiting, and difficulty swallowing during an influenza A infection. Initial chest radiography demonstrated subcutaneous emphysema, pneumomediastinum, and a small left apical pneumothorax, raising concern for Boerhaave syndrome. CT confirmed pneumomediastinum without evidence of oesophageal perforation, which was further excluded by a water-soluble contrast swallow study. A viral screen was positive for influenza A. She was managed conservatively with broad-spectrum antimicrobials, oseltamivir, nil by mouth, and parenteral nutrition until Boerhaave syndrome was excluded, followed by gradual reintroduction of diet and supportive therapy. Her symptoms resolved completely. This case highlights the potential synergistic effect of viral respiratory infection and vaping in precipitating Hamman's syndrome in otherwise healthy young adults and underscores the importance of distinguishing this benign entity from life-threatening differential diagnoses such as oesophageal rupture.