Presentation
Two day history of abdominal pain and retching.
Patient Data
Frontal and lateral radiographs reveal pnemomediastinum (black arrows). Note is also made of subcutaneous emphysema (red arrow) along the chest wall, more prominent along the right than left.
Case Discussion
The patient was stable. Given the patient's history of retching, a Mallory-Weiss tear or Boerhaave syndrome was suspected and had to be ruled out. A CT chest (not shown) was performed and did not have any additional findings. An oesophogram was performed (not shown) which revealed no esophageal tear. The pneumomediastinum was then presumed to be due to air leakage (i.e. alveolar rupture) secondary to the excessive elevation of intrathoracic pressure due to retching.
The patient was monitored for a couple of days. The pneumomediastinum and subcutaneous emphysema resolved on its own on sequential radiographs (not shown) and discharged home uneventfully.
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