UMEM Educational Pearls

Title: What's the Diagnosis?

Category: Visual Diagnosis

Posted: 5/23/2011 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

50 yo female s/p motor vehicle crash. Diagnosis?

Answer: Pneumomediastinum from pneumothorax

Pneumomediastinum

Mediastinal air has multiple causes:

Intrathoracic injury (e.g., Pneumothorax)
Upper respiratory tract (e.g., Injury during intubation)
Digestive tract perforation (e.g., Boerhaave’s syndrome)
Intra-abdominal perforation (e.g., EGD complication)
Anaerobic infection at sites communicating with mediastinum
- Ludwig’s angina
- Pneumoperitoneum
- Bacterial mediastinitis

Listen for Hamman's sign ("crunching" with cardiac auscultation) and feel for crepitus (distinct feeling on palpation).

Treat the precipitating cause.

Usually resolves without mediastinal decompression; air travels along tissue planes decompressing increased mediastinal pressure.