Pneumomediastinum diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]
Overview
Pneumomediastinum can present with a various range of symptoms from sudden acute chest pain, SOB, cough to no symptoms at all. Diagnosis of pneumomediastinum depends on the associated or precipitating condition. On physical exam, pneumomediastinum is associated with a specific sign known as Hamman's sign, which is the presence of mediastinal crunch or click present on auscultation over the cardiac apex and the left sternal border synchronous with the heartbeat. pneumomediastinum can routinely be diagnosed by chest X-ray. Diagnostic investigation of choice for pneumomediastinum is CT-scan of the chest.
Diagnostic Study of Choice
Study of choice
The diagnostic study of choice for pneumomediastinum is CT-scan of the chest.
Diagnostic results
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 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 pericardium.
- Gas between parietal pleura and diaphragm: extrapleural sign.
- Gas in pulmonary ligament.
Pediatric pneumomediastinum have different appearances:
- Elevated thymus: thymic wing sign.
- Gas crossing the superior mediastinum: haystack sign (the heart appears like a haystack in a Monet painting).
Sequence of Diagnostic Studies
| Symptomatic patient with the suspision of pneumomediastinum | |||||||||||||||||||||||||||||||||||||||||||
| Chest X-ray | |||||||||||||||||||||||||||||||||||||||||||
| Positive for PNM | Inconclusive | ||||||||||||||||||||||||||||||||||||||||||
| No Known causative factor identified | Underlying pathological cause identified | CT chest | |||||||||||||||||||||||||||||||||||||||||
•Observe patient in the hospital •Discharge if symptoms resolve •Follow up until complete resolutution of symptoms | Treat underlying pathology | ||||||||||||||||||||||||||||||||||||||||||
Name of Diagnostic Criteria
There are no established criteria for the diagnosis of pneumomediastinum.