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Despite the concerning elevation in troponin levels, minimal variation in serial measurements (&lt;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.\u202f<\/jats:p>","DOI":"10.1136\/bcr-2025-268111","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:15:19Z","timestamp":1764785719000},"page":"e268111","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Elevated troponin in a patient with pneumomediastinum and pneumothorax: a diagnostic challenge"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1326-5441","authenticated-orcid":false,"given":"Dissanayake Mudiyanselage Chanaka","family":"Jayawardena","sequence":"first","affiliation":[{"name":"Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8097-441X","authenticated-orcid":false,"given":"Rohan","family":"Suthar","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Sutton","sequence":"additional","affiliation":[{"name":"Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"De Bono","sequence":"additional","affiliation":[{"name":"Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"2025120310151347000_18.12.e268111.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2006.11.156"},{"key":"2025120310151347000_18.12.e268111.2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj\/051291"},{"key":"2025120310151347000_18.12.e268111.3","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.rmedc.2011.03.005","article-title":"Spontaneous pneumomediastinum revisited","volume":"4","author":"Meireles","year":"2011","journal-title":"Respir Med CME"},{"key":"2025120310151347000_18.12.e268111.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2003.09.021"},{"key":"2025120310151347000_18.12.e268111.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2008.04.067"},{"key":"2025120310151347000_18.12.e268111.6","doi-asserted-by":"crossref","DOI":"10.1002\/ccr3.5156","article-title":"Spontaneous pneumomediastinum mimicking acute pericarditis","volume":"9","author":"Chaudhary","year":"2021","journal-title":"Clin Case Rep"},{"key":"2025120310151347000_18.12.e268111.7","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-194412000-00001"},{"key":"2025120310151347000_18.12.e268111.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2007.03.008"},{"key":"2025120310151347000_18.12.e268111.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2009.10.007"},{"key":"2025120310151347000_18.12.e268111.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.08.1038"},{"key":"2025120310151347000_18.12.e268111.11","doi-asserted-by":"crossref","first-page":"bcr","DOI":"10.1136\/bcr-2018-227932","article-title":"Pneumomediastinum, ST elevation and urgent cardiac catheterisation: a crucial triad?","volume":"12","author":"Frenkel","year":"2019","journal-title":"BMJ Case Rep"},{"key":"2025120310151347000_18.12.e268111.12","doi-asserted-by":"crossref","DOI":"10.3390\/jpm12081244","article-title":"The Octopus Trap of Takotsubo and Stroke: Genetics, Biomarkers and Clinical Management","volume":"12","author":"Canavero","year":"2022","journal-title":"J Pers Med"},{"key":"2025120310151347000_18.12.e268111.13","doi-asserted-by":"crossref","unstructured":"Cavallari C , Ayoub B , Mateja C . 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