PEDIATRICS Vol. 81 No. 1 January 1988, pp. 134-136
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Mediastinal Emphysema in an Adolescent With Anorexia Nervosa and Self-Induced Emesis

Kim J. Overby MD1 and Iris F. Litt MD1

1 From the Divisions of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California

A case of asymptomatic pneumomediastinum in a 14-year-old girl with anorexia nervosa and self-induced emesis is reported to emphasize the atypical aspects of this case and the importance of differentiating benign from potentially life-threatening sources of mediastinal air. Individuals who engage in purging behavior are not only at increased risk for both alveolar (primary pneumomediastinum) and esophageal perforation (Boerhaave syndrome) but may also obscure or delay the diagnosis by denying symptoms and/or previous emesis. Because esophageal perforation is serious, the presence of free mediastinal air in a patient with a known or suspected history of emesis should provoke prompt radiographic evaluation of the upper gastrointestinal tract.

Key Words: pneumomediastinum • mediastinal emphysema • anorexia nervosa • bulimia • emesis • eating disorder • Boerhaave syndrome • esophageal perforation

Submitted on February 27, 1987
Accepted on April 13, 1987




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D. E. Adson, S. J. Crow, and J. E. Mitchell
Spontaneous Pneumothorax in Anorexia Nervosa
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