CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 32 Pneumomediastinum

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig C 32-1 Pneumomediastinum. In addition to bilateral elevation of the
mediastinal pleura (closed arrows), there is a characteristic interposition
of gas between the heart and the diaphragm that permits visualization of
the central portion of the diaphragm in continuity with the lateral portions
(open arrows).62

4. • Fig C 32-2 Positive-pressure ventilation. After
intubation and ventilation of a child with
hydrocarbon poisoning, there is the development
of a pneumomediastinum (large arrow) and
pneumothorax (small arrow). Note that the
stiffness of the lungs has prevented substantial
collapse

5. • Fig C 32-3 Esophageal rupture. Linear lucent
shadows (arrows) represent localized mediastinal
emphysema and correspond to the fascial planes
of the mediastinal and diaphragmatic pleurae in
the region of the lower esophagus.52

6. • Fig C 32-4 Tracheobronchial injury. Frontal chest film made after blunt trauma to the upper chest
that caused transection of both main-stem bronchi demonstrates free air in the mediastinum
(upper black arrows) and through the fascial planes of the neck. The lucent zone (lower black
arrows) along the left cardiac border simulates the pattern produced by a pneumopericardium or
pneumothorax. However, the aortic arch is sharply circumscribed by air that extends around its
cephalad and right lateral margins, at a level well above the pericardial reflection (white arrows).
This clearly indicates that this air also is in the mediastinum and not confined to the pericardium or
pleural space.4

7. • Fig C 32-5 Extension of gas from the neck.
Pneumomediastinum (arrows ) after cervical
trauma (note the overlying surgical drain on the
right).

8. • Fig C 32-6 Pneumomediastinum in an infant.
(A) Elevation of both thymic lobes by
mediastinal air (white arrows and black
arrowheads) produces the angel's-wings sign.
(B) Lateral projection shows the anterior
mediastinal air lifting the thymus off the
pericardium and great vessels (arrow).