[Epidural, mediastinal and subcutaneous emphysema in a patient with suspected torme fruste of Marfan syndrome].
A 17 year-old youth presented with swelling of both sides of neck after a fight with a friend. He had been sick with an upper respiratory tract infection for a few days with frequent coughing. Chest radiography showed subcutaneous and mediastinal emphysema. Neck CT at the level of C7 showed air around the trachea, extending to the subcutaneous tissue and the epidural space through the intervertebral foramen. His height was 180 cm and his weight 55 kg, and he had a 181 cm arm span. He had scoliosis and arachnodactyly, and ultrasonic cardiography demonstrated mitral and tricuspid regurgitation. These findings agreed partially with the clinical criteria of Marfan syndrome. Thus, forme fruste of Marfan syndrome was suspected. A rapid rise of airway pressure induced by a coughing attack and loud shouting during the fight probably caused the laceration of the connective tissue in the airway, resulting in mediastinal and epidural emphysema. In this case report, CT at the C7 level satisfactorily identified air in the mediastinum extending to the epidural space through intervertebral foramen.