Pneumomediastinum and subcutanous emphysema

Case contributed by Dr Andrew Ho

Presentation

27 year old male presented with abdominal pain and retching for 2 days.

Patient Data

Age: 27
Gender: Male

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 esophogram 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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Case information

rID: 22938
Case created: 5th May 2013
Last edited: 23rd Feb 2016
System: Chest
Inclusion in quiz mode: Included

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