Pneumomediastinum and subcutanous emphysema
Two day history of abdominal pain and retching.
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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.
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.
- Caceres M, Ali SZ, Braud R et-al. Spontaneous pneumomediastinum: a comparative study and review of the literature. Ann. Thorac. Surg. 2008;86 (3): 962-6. doi:10.1016/j.athoracsur.2008.04.067 - Pubmed citation
- Takada K, Matsumoto S, Hiramatsu T et-al. Management of spontaneous pneumomediastinum based on clinical experience of 25 cases. Respir Med. 2008;102 (9): 1329-34. doi:10.1016/j.rmed.2008.03.023 - Pubmed citation