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Sudhir Kumar Rana, Ragini Singh, Chhavi S Nanda
Department of Pediatrics, SGRRIM & HS, Dehradun, India.

Address for Correspondence: Dr Sudhir Kumar Rana, Department of Pediatrics, SGRRIM & HS, Dehradun, India. 248001. Email:

A 15 month old female child presented with fever, vomiting and diarrhea for 4 days followed by severe respiratory distress and swelling of chest after a violent bout of vomiting. On examination, she was febrile, had tachypnea and tachycardia with subcutaneous emphysema (SCE) with positive rice crispies sign (palpatory feel of tissue paper to detect subcutaneous emphysema) and a crunching, rasping sound synchronous with the heartbeat heard over the precordium in the left lateral position suggestive of spontaneous pneumomediastinum (SPM). Systemic examination was normal. Chest X ray showed bilateral pneumonitis, extensive SPM and SCE without pneumothorax. CT thorax confirmed these findings. The patient got some relief of SCE by skin incisions and improved gradually.

What is the diagnosis_?

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