What are the findings?
Air in the posterior mediastinum, right sided pleural effusion and basal atelectasis. Patchy bilateral consolidation.
What are some causes of pneumomediastinum?
Oesophageal rupture (eg. Mallory-Weiss tear; Boerhaave syndrome), alveolar rupture or bowel perforation. Post-surgical is also a possibility (iatrogenic).
How would you further assess this patient in respect to source of pneumomediastinum?
Contrast swallow.
What contrast would you use?
Water soluble (e.g. CT / angio contrast) not Barium (bad in the mediastinum) or Gastrographin (bad in the lungs).
Right sided pleural effusion with right basal atelectasis. Patchy consolidation is noted in the right and left lower lobes with surrounding tree-and-bud and centrilobular nodules most consistent with aspiration pneumonia. Air is noted in the posterior mediastinum adjacent to the oesophagus and extending along the left major fissure.