Complaint :
17 years male patient suffering with
seasonal bronchial Asthama & Cough from last 2 years.
Two days back severe Asthamatic attack
with cough. No H/o Trauma / vomtings.
Clinical Findings : Swelling of the
chest wall with crepitus on palpation.
Findings :
Minimal air in the mediastinum surrounding vascular structures,
oesophagus & Trachea.
Subcutanous and intermuscular
planes shows air density in the anterior & posterior chest wall
extending into
bilateral axilla.
Small pockets of air in the
spinal canal on either side of the spinal cord at
multiple levels.
Diagnosis :
Spontaneous pneumomediastinum with Pneumorachis
(air in the spinal canal) &
Surgical Emphysema.
Discussion :
Spontaneous
Pneumomediastinum commonly occur in the 2nd -3rd decade
Common Cause
are:
1. Rupture of marginally situated alveoli from sudden / prolonged
rise
in intraalveolar pressure with subsequent dissection of air
centrally along
bronchovascular bundles to hila (interstitial emphysema) + rupture
into
mediastinum: Valsalva maneuver, status asthmaticus, aspiration
pneumonia,
hyaline membrane disease, measles, giant cell pneumonia, coughing,
vomiting,
strenuous exercise, parturition, diabetic acidosis, crack cocaine
inhalation = free-basing
(mixing solid cocaine salt with a solvent to render it "smokeable")
2. Tumor erosion of trachea / esophagus
3. Pneumoperitoneum / retropneumoperitoneum = extension from
peritoneal /
retroperitoneal / deep fascial planes of the neck.
Reference:
Radiology Review Manual Fifth edition-
Wolfgang Dahnert &
Diagnostic Imaging, CHEST,First edition - Gurney, Winer-Muram,
Stern.
