Presentation
While eating her meal, the patient had a sudden sensation of food impaction. Patient self-induced vomiting, for which after 2 episodes of forceful vomiting, she felt a sharp retrosternal pain. At the emergency department, the patient had complaints of chest pain and difficulty breathing.
Patient Data
Extensive pneumomediastinum is noted, extending superiorly into the neck and inferiorly around the descending thoracic aorta into the upper abdomen (retroperitoneum).
Surgical emphysema is noted along the upper anterior chest wall and the root of the neck on both sides.
Bilateral moderate pleural effusion with underlying basal segmental collapse of both lower lobes is observed.
Surgical emphysema is noted in the lower cervical soft tissue.
Pneumomediastinum is noted.
Diffuse bilateral opacification due to pleural effusions is observed.
A small gas shadow adjacent to the gastric bubble suggests pneumoperitoneum.
Case Discussion
Pneumomediastinum is the presence of air in the mediastinal space. It can be primary or secondary. Primary pneumomediastinum is spontaneous and often associated with smoking. The secondary type is due to trauma, iatrogenic causes, airway disease, vomiting, or foreign body impaction, as in our case.
Our patient presented with respiratory distress and was intubated. She underwent further endoscopy, and esophageal perforation was confirmed.
This case was also reviewed by Dr. Yasmin H. Kazim and Dr. Ahmad Hisham Sakah.
Image courtesy of Dr. Priyank Gupta.
Unable to process the form. Check for errors and try again.