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A 48-year-old woman from the Scottish Borders presented to her general practitioner with exertional dyspnoea. There was a delay in diagnosis of the underlying respiratory condition, due to initial investigations being suggestive of cardiac disease. Subsequently, the patient developed clinical symptoms and signs of pneumomediastinum, which was discovered on radiological imaging. Detailed history-taking and further clinical testing confirmed the cause of this to be hypersensitivity pneumonitis due to sensitisation to pet birds. The patient was treated with high dose steroids and went on to make a good recovery. The birds were rehomed.

bmj case reports

Pneumomediastinum: a rare manifestation of hypersensitivity pneumonitis in a patient presenting with unexplained breathlessness at the Borders General Hospital