Pneumomediastinum CT

Pneumomediastinum Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The diagnosis can be confirmed via chest X-ray showing a radiolucent outline around the heart and mediastinum or via CT scanning of the thorax.

CT

The following finding(s) on performing CT-scan of the chest is confirmatory for pneumomediastinum:

• Subcutaneous emphysema.
• Naclerio V sign: Seen in pneumomediastinum occurring often secondary to an oesophageal rupture but it is not entirely specific to that condition.
• Gas anterior to pericardium: pneumopericardium.
• Gas around the pulmonary artery and main branches: ring around artery sign.
• Gas outlining major aortic branches: tubular artery sign.
• Gas outlining bronchial wall: double bronchial wall sign.
• Continuous diaphragm sign: due to gas trapped posterior to the pericardium.
• Gas between parietal pleura and diaphragm: extrapleural sign.
• Gas in pulmonary ligament.

Pediatric pneumomediastinum has different appearances:

• Elevated thymus: thymic wing sign.
• Gas crossing the superior mediastinum: haystack sign (the heart appears like a haystack in a Monet painting).

• 
  A CT scan showing air in the mediastinum

Images shown below are courtesy of RadsWiki.

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  Pneumomediastinum
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  Pneumomediastinum

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  Pneumomediastinum and pneumothorax
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  Pneumomediastinum and pneumothorax

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  Pneumomediastinum and pneumothorax and subcutaneous emphysema