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Pneumomediastinum after shallow water diving

Case contributed by: Dr Erik Ranschaert

Presentation:

This boy has been diving in a normal swimming pool and presented at the hospital with painful respiration and a painful neck. Clinical examination revealed some diminished breathing over the left lung. The pain started after a "wrong dive".

Patient Data:

Age: 17

Gender: Male

Race: Caucasian

From the case: Pneumomediastinum after shallow water diving

Modality: X-ray

Chest AP

Radiolucent streaks of air outline the upper mediastinal structures, mainly on the left side: pneumomediastinum. Subcutaneous emphysema is also noted in the left base of the neck. No pneumothorax is demonstrated.

Case Discussion:

Increases in intrathoracic pressure due to coughing or ascending while breath-holding can result in substantial pulmonary barotraumas due to transient increases in intra-alveolar and intrabronchiolar pressure, even when diving in shallow water.

Imaging is important in determining the extent and presence of pneumomediastinum. Chest radiographs typically show radiolucent streaks of air outlining other structures tracking vertically. Subcutaneous emphysema is also often demonstrated radiographically.