Presentation
Chest pain after a fall.
Patient Data
Subcutaneous emphysema noted over the root of the neck. Pneumomediastinum is also present, best seen on the lateral as a lucency anterior to the ascending aorta. No rib fracture or other bony injury is identified. Cardiomediastinal contour is normal.
Changes of pneumomediastinum have progressed mildly from the previous x-ray, particularly well seen lateral to the superior left heart border.
Case Discussion
The pneumomediastinum on the first images is not grossly obvious. However, the subcutaneous emphysema in the root of the neck is clearly visible, and the presence of this should always prompt a careful search for pneumomediastinum.