US doctors have detected a “unique” link between intense exercise and pneumomediastinum, after a young cyclist presented with chest tightness and dyspnoea without any typical triggers or causes. 

The 23-year-old’s summer routine included cycling for two hours every day, but on the day in question he continued for three and half hours before needing to stop due to feeling unwell. 

When his symptoms — a change in his voice quality that progressed to tightness in his chest and neck — failed to improve with rest, he presented to ED. 

He had clinically stable asthma controlled with albuterol, mometasone and montelukast, but reported no recent exacerbations or other associative risk factors including fever and COVID-19 exposure.