Bronchiolitis with pneumomediastinum

Case contributed by Dr Jeremy Jones

Presentation

Worsening difficulty in breathing that has become worse over the last 24-48 hours.

Patient Data

Age: 22 months
Gender: Female

Bilateral peribronchial thickening with patchy consolidation extending from the hilar in the upper zones. Further patchy consolidation at the left base. No effusion. Features consistent with bronchiolitis.

X-ray

4 hours later

Despite observation and low-flow oxygen therapy, acute deterioration prompts a repeat chest radiograph. There is increased lucency around the mediastinal contour and a continuous diaphragm sign that point towards pneumomediastinum.

Case Discussion

22 month old with symptoms suggestive of bronchiolitis and a radiograph that fits the story.

The vast majority of these patients will be discharged home with no further treatment. A small proportion will be admitted for observation. Most of the children who are observed will improve with some nasal oxygen and require no further treatment.

Spontaneous air-leak is a complication of bronchiolitis. Gas usually dissects up the axial interstitium towards the hila resulting in pneumomediastinum and, depending on the volume of gas, surgical emphysema in the neck. This may all occur in the absence of pneumothorax.

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Case information

rID: 35348
Case created: 2nd Apr 2015
Last edited: 29th Jul 2017
System: Paediatrics
Inclusion in quiz mode: Included

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