Elevated troponin in a patient with pneumomediastinum and pneumothorax: a diagnostic challenge
Jayawardena, Dissanayake Mudiyanselage Chanaka Suthar, Rohan Sutton, Benjamin De Bono, Joseph
Jayawardena, Dissanayake Mudiyanselage Chanaka
Suthar, Rohan
Sutton, Benjamin
De Bono, Joseph
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Publication date
2025-12-03
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Abstract
We present the case of a middle-aged man who was admitted with acute chest pain and markedly elevated troponin levels, initially raising concerns for acute coronary syndrome. Diagnostic evaluations revealed an apical pneumothorax, and pneumomediastinum, without evidence of dynamic ischaemic ECG changes. Despite the concerning elevation in troponin levels, minimal variation in serial measurements (<10%) indicated a non-ischaemic aetiology. The troponin elevation was attributed to stress from pneumomediastinum, localised inflammation and myocardial strain. This case highlights the importance of differentiating ischaemic and non-ischaemic causes of troponin elevation to avoid unnecessary interventions. Conservative management focused on diagnostic stewardship resulted in a favourable outcome. Given the rarity of such presentations, we aim to publish this case to enhance understanding and emphasise the importance of considering pneumomediastinum in patients presenting with chest pain and elevated cardiac biomarkers.
Citation
Jayawardena DMC, Suthar R, Sutton B, De Bono J. Elevated troponin in a patient with pneumomediastinum and pneumothorax: a diagnostic challenge. BMJ Case Rep. 2025 Dec 3;18(12):e268111. doi: 10.1136/bcr-2025-268111.
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