January 28, 2009


Fig. 1: A chest radiograph of a 29-year-old man with severe vomiting shows subtle streaks of lucencies in the mediastinum (along the left heart border - arrows), and into the cervical region (arrowheads).
Fig. 2: Coronal-reformatted chest CT image confirms the presence of pneumomediastinum (arrows) and cervical emphysema (arrowheads). A small left pneumothorax is noted on CT (not shown). No esophageal, tracheal or major broncheal perforation was noted on esophagoscopy and bronchoscopy.

Radiographic Findings of Pneumomediastinum (= normal mediastinal structures outlined by air)

  • Thymic sail sign
  • Pneumoprecardium (lateral chest radiograph)
  • Ring around the artery sign
  • Tubular artery sign
  • Continuous diaphragm sign

Sources of Pneumomediastinum
  • Intrathoracic: trachea, major bronchi, esophagus, lungs, pleural space
  • Extrathoracic: head and neck (sinus), intraperitoneum and retroperitonum (hollow viscus)

In our case, pneumomediastinum was presumed to be due to alveolar rupture from severe vomiting.

Zylak CM, Standen JR, Barnes GR, Zylak CJ. Pneumomediastinum revisited. Radiographics 2000;20:1043-1057.

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