Pneumomediastinum can occur after both blunt and penetrating trauma. The greatest concern involving this finding in a trauma patient is an aerodigestive tract injury. Prompt evaluation, identification, and management of these injuries are extremely important. This case describes a soldier who was involved in an improvised explosive device blast with no evidence of cavity penetration. During the routine evaluation of his head and neck an occult pneumomediastinum was identified. The patient was asymptomatic and was further evaluated with computed tomography because of the absence of endoscopy and bronchoscopy in theatre. The imaging showed no evidence of esophageal or tracheobronchial injury. The patient was observed and when noted to be stable was transferred to the local Role 3 hospital for management of his other injuries.
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