Medical Image of the Week: Pneumomediastinum

Figure 1. Chest X-ray PA view.

Figure 2. CT scan of chest.

A 38-year-old gentleman was flown to the emergency room after being involved in a motor vehicle accident. In the field, he had a Glasgow Coma Scale of about 7 and cricothyrotomy was performed to establish an airway. He sustained severe head and chest injuries, with extensive subcutaneous emphysema.  Chest X-ray (Figure 1) and CT scan (Figure 2) revealed pneumomediastinum with classical “continuous diaphragm sign” (red arrows), lucent streaks outlining the ascending aorta (blue arrows) and extensive subcutaneous emphysema (block arrows). Subdural and subarachnoid hemorrhage was detected on CT scan of head. His neurological status worsened over next 24 hours and he was confirmed brain dead.

Ramasubramanian Baalachandran MD, Naser Mahmoud MD, and Laura Meinke MD

Department of Medicine

University of Arizona

Tucson, Arizona

References

1. Bejvan SM, Godwin JD. Pneumomediastinum: old signs and new signs. AJR Am J Roentgenol. 1996;166:1041-8. [CrossRef] [PubMed]
2. Levin B. The continuous diaphragm sign. A newly-recognized sign of pneumomediastinum. Clin Radiol.1973;24(3):337-8. [CrossRef] [PubMed]

Reference as: Baalachandran R, Mahmoud N, Meinke L. Medical image of the week: pneumomediastinum. Southwest J Pulm Crit Care. 2014;9(3):189-90. doi: http://dx.doi.org/10.13175/swjpcc123-14 PDF