Pneumomediastinum, pneumoperitoneum and subcutaneous emphysema

Case contributed by Dr Bruno Di Muzio

Presentation

Traumatic complication after tracheal intubation attempt.

Patient Data

Age: 80 years
Gender: Male

Extensive pneumomediastinum that extends into the retroperitoneum.

Pneumoperitoneum is also partially imaged, with typical falciform ligament sign and Rigler sign.

Subcutaneous emphysema tracks along the superior aspect of the anterior thoracic wall and neck soft tissues.

No pneumothorax. 

Case Discussion

Pneumomediastinum is the presence of extraluminal gas within the mediastinum. Gas may come from lungs, trachea, central bronchi, esophagus, and the neck or abdomen.

Pneumoperitoneum represents free gas in the peritoneal cavity. 

Subcutaneous emphysema, strictly speaking, refers to air in the subcutaneous tissues. But the term is generally used to describe any soft tissue emphysema of the body wall or limbs since the air often dissects into the deeper soft tissue and musculature along fascial planes.

This patient developed those abnormalities after traumatic insertion of a tracheal tube. 

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