Case contributed by Henry Knipe


ICU. Intubated. Routine x-ray.

Patient Data

Age: 50 years
Gender: Male

Patient is intubated with a left central venous catheter. NGT with tip in the mid-esophagus. Bibasal opacities. Lucency outlines the heart with a small volume of subcutaneous emphysema in the root of the neck. 

Eight hours later


Extensive pneumomediastinum (including small volume pneumopericardium) and subcutaneous emphysema. No pneumothorax. Left psoas hematoma is partially imaged. 

Case Discussion

The most likely cause is barotrauma from positive pressure ventilation. Marked worsening in the 8 hours between studies is also seen. 

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