Pneumomediastinum

Case contributed by Derek Smith
Diagnosis certain

Presentation

Two days pleuritic chest pain, no shortness of breath. Tachycardic, normal oxygen saturations.

Patient Data

Age: 20 years
Gender: Male
x-ray

Small left apical pneumothorax.

Subcutaneous emphysema (vertical lucent stripes into neck) and "double bronchial wall sign" suggesting pneumomediastinum. Small rim of air at AP window.

Case Discussion

This is a classical appearance of pneumomediastinum.

With the imaging and the stable status of the patient, this was likely from alveolar rupture allowing air to track into the mediastinum which is a recognized cause of pneumomediastinum.

This can be managed conservatively.

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