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Pneumomediastinum. Tyler Bagley October 17, 2006. Objectives. 1. Recognize the causes of pneumomediastinum 2. Recognize the presentation 3. Identify common radiological signs 4. Discuss when to order additional tests 5. Treatment.

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Pneumomediastinum l.jpg

Pneumomediastinum

Tyler Bagley

October 17, 2006


Objectives l.jpg
Objectives

  • 1. Recognize the causes of pneumomediastinum

  • 2. Recognize the presentation

  • 3. Identify common radiological signs

  • 4. Discuss when to order additional tests

  • 5. Treatment


Pulmonary causes l.jpg

Rupture of the alveolus with air dissection along the peribronchial vascular sheaths into the hilum and mediastinum

Ruptured bleb with peripheral extension

Sudden rise in intrapulmonary pressure

Asthma, vomiting, forceful coughing, crying, shouting, Valsalva maneuver, artificial ventilation, closed chest trauma, sudden drop in atmospheric pressure, foreign body aspiration

Pulmonary Causes:


Trauma l.jpg
Trauma peribronchial vascular sheaths into the hilum and mediastinum

  • Rupture of trachea or mainstem bronchus, usually via accidental trauma

  • Trauma to the neck

  • Boerhaave’s Syndrome

  • Barotrauma


Mediastinum connections l.jpg
Mediastinum Connections peribronchial vascular sheaths into the hilum and mediastinum

  • The mediastinum communicates with the submandibular space, retropharyngeal space and vascular sheaths within the neck

  • Also can communicate with the retroperitoneum via sternocostal attachments to the diaphragm, as well as the periaortic and periesophageal fascial planes


Presentation l.jpg
Presentation peribronchial vascular sheaths into the hilum and mediastinum

  • Infants-typically none

  • Adults-

    • May complain of retrosternal chest pain radiating down both arms that is exacerbated by respiration and swallowing

    • Dyspnea-in association with asthma, tension PM or pneumothorax

    • Fever-due to cytokine release with an air leak

    • Throat or jaw pain, dysphonia, dysphagia, neck swelling and torticollis


Physical exam l.jpg
Physical Exam peribronchial vascular sheaths into the hilum and mediastinum

  • Subcutaneous Air

  • Associated Pneumothorax

  • Oxygen Saturations

  • Hamman’s Sign-

    • “Crunching” sound heard over the apex of the heart with the cardiac cycle


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Linear density parallel to the heart border peribronchial vascular sheaths into the hilum and mediastinum


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Extrapleural Sign peribronchial vascular sheaths into the hilum and mediastinum

  • Air from the mediastinum can extend laterally between the parietal pleura and the diaphragm to produce the extrapleural sign


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Double Bronchial Sign peribronchial vascular sheaths into the hilum and mediastinum

  • Air in the mediastinum and left main bronchus allows visualization of both sides of the bronchial wall.


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Spinnaker Sign (Thymic Sail Sign) peribronchial vascular sheaths into the hilum and mediastinum

With sufficient mediastinal air, the thymus can become elevated, creating the Thymic Sail Sign, or Spinnaker Sign.


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Newborn Pneumomediastinum peribronchial vascular sheaths into the hilum and mediastinum


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Air in Anterior Mediastinum peribronchial vascular sheaths into the hilum and mediastinum


Tubular artery sign l.jpg
Tubular Artery Sign peribronchial vascular sheaths into the hilum and mediastinum


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Continuous Diaphragm Sign peribronchial vascular sheaths into the hilum and mediastinum


Ring around the artery sign l.jpg
Ring around the Artery Sign peribronchial vascular sheaths into the hilum and mediastinum


Chest ct l.jpg
Chest CT peribronchial vascular sheaths into the hilum and mediastinum


Diagnostic procedures l.jpg
Diagnostic Procedures peribronchial vascular sheaths into the hilum and mediastinum

  • Chest tube in coexisting pneumothorax

  • Bronchoscopy if tracheobronchial perforation is suspected

  • Esophagoscopy if an esophageal perforation is suspected


Treatment l.jpg
Treatment peribronchial vascular sheaths into the hilum and mediastinum

  • Mechanical ventilation with low pressure or tidal volumes

  • Mediastinoscopy to alleviate life-threatening pneumomediastinum

  • Percutaneous placement of mediastinal drains


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The End. peribronchial vascular sheaths into the hilum and mediastinum


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