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.
Dissanayake Mudiyanselage Chanaka Jayawardena (Mon,) studied this question.