Pneumomediastinum

Case contributed by A.Prof Frank Gaillard

Presentation

Collapse at home. Intubated at the scene by paramedics. CT demonstrated a subdural hemorrhage (not shown) which was evacuated. Patient now in ICU.

Patient Data

Age: 80-year-old
Gender: Male

Chest x-ray

Modality: X-ray

CXR demonstrates the patient to be intubated with CVC and NGT in situ. Extensive pneumomediastinum is seen, extending into the neck and outlining the pericardium.

CT chest

Modality: CT

CT of the chest demontrastes ETT, NGT and Right central line appropriately positioned.
Extensive pneumomediastinum and subcutaneous emphysema noted. Contained contour irregularity in the distal trachea, just above the carina measures 1cm TV x 3.5cm long, is likely to be the source of the gas.

Small bilateral effusions. No pneumothorax. Minor patchy air space opacity, in keeping with atelectasis. There are multiple small nodule, 4mm and less in both lungs. Heart and aorta within normal limits on this unenhanced CT.

Conclusion:

Distal tracheal contour irregularity. It is difficult to precisely measure the size of the defect, which would be better assessed on bronchoscopy.

Case Discussion

This patient was treated conservatively and gradually improved.

Tracheal trauma is often iatrogenic, often the result if difficult emergency intubation. In many cases they can be treated conservatively (as in this case) although clearly positive pressure ventilation can be problematic.

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Case Information

rID: 14464
Case created: 28th Jul 2011
Last edited: 10th Nov 2015
Inclusion in quiz mode: Included

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