Presented in the emergency department with worsening shortness of breath.
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Air is seen projecting over the heart shadow extending into the superior mediastinum representing pneumomediastinum. NG tube in place.
Pneumomediastinum is the presence of extraluminal gas within the mediastinum. It is distinguished from pneumopericardium as the air in the pericardial sac should not rise above the anatomic limits of the pericardial reflection on the proximal great vascular pedicle. Note the air extending beyond the great vascular pedicle denoting the air to be in the mediastinum.