Case contributed by Dr Henry Knipe


Forceful vomiting all night. Now chest pain.

Patient Data

Age: 25 years
Gender: Male

Extensive subcutaneous emphysema and pneumomediastinum. No pleural effusion. 


Extensive pneumomediastinum and subcutaneous emphysema. Bilateral pneumothoraces with air tracking along the pleural fissures. Gas also tracks into the thoracic epidural space.

No mediastinal or pleural fluid collection. No leak of oral contrast from the esophagus. 

Case Discussion

Pneumomediastinum can have a dramatic appearance on imaging. In this case with the history of forceful vomiting, esophageal rupture was concerning but the imaging features are against this a cause and this is more likely from pulmonary in origin (Macklin effect). 

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Case information

rID: 53639
Published: 16th Jun 2017
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included

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