Spontaneous pneumomediastinum, pneumorrhachis, and subcutaneous emphysema secondary to hyperemesis gravidarum: A case report.

Spontaneous pneumomediastinum is a rare complication of hyperemesis gravidarum and may present with alarming symptoms that mimic more serious conditions, particularly esophageal perforation. A 20-year-old primigravida in the first trimester (11 weeks of gestation) presented with severe vomiting, facial swelling, odynophagia, and cervical crepitus. Imaging studies revealed spontaneous pneumomediastinum, pneumorrhachis, and extensive subcutaneous emphysema. Esophageal perforation was excluded by contrast esophagography. The patient developed electrolyte disturbances and acute kidney injury secondary to hyperemesis gravidarum and was successfully managed with intravenous fluid replacement, oxygen therapy, and close maternal-fetal surveillance. Clinical improvement occurred within five days, allowing hospital discharge without complications. The remainder of the pregnancy was uneventful, and a healthy female infant was delivered at term. This case highlights the importance of recognizing spontaneous pneumomediastinum as a potential complication of severe hyperemesis gravidarum. Associated pneumorrhachis is exceptionally uncommon and may lead to diagnostic uncertainty. Early recognition, exclusion of esophageal injury, and conservative multidisciplinary management may result in favorable maternal and neonatal outcomes.