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Pneumomediastinum

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Pneumomediastinum

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    1. Pneumomediastinum Gregory R. Ball, Ph.D. SUNY Buffalo

    2. Pneumomediastinum Pneumomediastinum (PM), or mediastinal emphysema, is defined as the presence of gas in the mediastinum. Causes: Trauma Iatrogenic Endotracheobronchial or endoesophageal procedures Mechanical ventilation Cardiac catheterization Thoracic Surgery Spontaneous (SPM)

    3. Mechanism

    4. Signs and Symptoms Chest pain, SOB, neck pain and discomfort Chest pain is the most common symptom, and it typically presents as an acute, retrosternal, pleuritic pain that may radiate to the neck, back, or shoulders Other, less common symptoms include odynophagia, dysphagia, dysphonia, cough, back pain, or abdominal pain Physical examination may reveal signs of respiratory distress, subcutaneous emphysema, and the Hamman sign, which is pathognomonic for pneumomediastinum. The Hamman sign refers to crunching, crackling, or bubbling sounds that are synchronous with the heart beat on auscultation. This signifies air in the mediastinum.

    5. Radiographic Signs of Pneumomediastinum Vertical lucent streak along the left side of the heart and aortic arch, showing the pleura as a fine opaque line, on frontal view. Retrosternal, precardiac, periaortic, and peritracheal lucent streak on the lateral view. Continuous diaphragm sign: interposition of air between pericardium and diaphragm, the latter becoming visible in its central mediastinal part in continuity with the two diaphragm domes. Naclerio’s V sign: dual linear v-shaped radiolucency, one along the left-hand edge of the aorta and the other creating the continuous diaphragm sign to the left. Ring around the artery sign: radiolucency around the right pulmonary artery on lateral view. Spinnaker sign in infants: upwards and outwards deviation of thymic lobes. Extrapleural air sign: linear or cuvilinear lucency interposed between pleura and diaphragm (usually), but also the sternum and apex. Indirect signs: thoracic and cervical subcutaneous emphysema, pneumopericardium, pneumoretroperitoneum, and pneumoperitoneum.

    6. Vertical and Paratracheal Lucent Streaks Vertical lucent streak along the left side of the heart and the aortic arch, showing the pleura as a fine opaque line (long arrows). Linear paratracheal lucent streak (short arrows).

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