Presentation
?Pneumothorax.
Patient Data
Streaky linear lucencies in the superior mediastinum and air tracking down the mediastinal borders bilaterally, is consistent with moderate volume pneumomediastinum. The anterior junctional line is outlined by air. No overt extension into the neck. Small right apical pneumothorax outlines the lobulated border between apical segment of the lungs and the incidental azygos lobe. Cardiac size is normal. Lungs and pleural spaces clear. No free subdiaphragmatic gas.
Case Discussion
Differentials include asthma (in the right clinical context), or alternatively an esophageal or tracheal perforation (?related to ingested food/foreign body) or Boerhaave's syndrome (spontaneous esophageal rupture).
This could be further characterized with CT chest.
Acknowledgement: Dr Joe Paiva.
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