A 40‐year‐old man developed swelling of the face and neck associated with respiratory distress of sudden onset. These symptoms followed a yoga exercise called “pranayam”, which had involved a vigorous Valsalva manoeuvre. Clinically, he had subcutaneous emphysema in the neck, more predominant on the right side, and tachypnoea. Cervical radiographs showed air in the retropharyngeal space (fig 1), parapharyngeal spaces and subcutaneous emphysema. Chest radiograph showed pneumomediastinum. Subcutaneous emphysema, air in the retroparapharyngeal spaces and pneumomediastinum are usually complications of surgical procedures on the upper aerodigestive tract, trauma, intubations or ventilator malfunction, but they can occur after a Valsalva manoeuvre or spontaneously.
Figure 1 Radiograph showing air in the retropharyngeal space.