Peumomediastinum

Background

• Also known as mediastinal emphysema
• Definition: air present in the mediastinum

Causes

• Esophageal rupture
• Asthma/COPD
• Bowel rupture or other cause of air in abdominal cavity (tracts up into the chest)
• Mycoplasma pneumoniae pneumonia
• Environmental barotrauma (e.g. scuba diving, flight)
• Iatrogenic (e.g. during thoroscopy/VATS)
• Blunt chest trauma

Clinical Features

• Chest pain
• Dyspnea
• Voice distortion
• Subcutaneous emphysema, especially of face, neck, and chest.
• "Crunching" sound on auscultation, timed with the cardiac cycle (Hamman's crunch)
• May mimic cardiac tamponade

Diagnosis

Traumatic pneumomediastinum and right sided pneumothorax with first rib fracture.

Pneumomediastinum with Angel wing sign

• CXR or chest CT
  • Radiolucent outline around the heart and mediastinum

Management

• Supplemental oxygen with non-rebreather

See Also

• Pneumothorax (main)