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, shortness of breath, 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.[1][2][3][4][5][6][7]
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
- 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
- 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
Sequence of diagnostic studies[8][9][10][11]
| 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 | ||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Taveras, J., & Ferrucci, J. (1986). Radiology. Diagnosis/imaging/intervention. 5 volumes. Annual revision service. R. Health Professions,Philadelphia, PA.
- ↑ Sandler, Carl M.; Llbshltz, Herman I.; Marks, Gerald; Libshitz, Herman I. (1975). "Pneumoperitoneum, Pneumomediastinum and Pneumopericardium Following Dental Extraction". Radiology. 115 (3): 539–540. doi:10.1148/15.3.539. ISSN 0033-8419.
- ↑ Kim, Hye Rin; Yoo, Seung Min; Lee, Hwa Yeon; Han, Jin Hee; Frazier, Aletta A; White, Charles S (2016). "Presence of subpleural pulmonary interstitial emphysema as an indication of single or multiple alveolar ruptures on CT in patients with spontaneous pneumomediastinum". Acta Radiologica. 57 (12): 1483–1489. doi:10.1177/0284185116629830. ISSN 0284-1851.
- ↑ Moseley, John E. (1960). "Loculated Pneumomediastinum in the Newborn". Radiology. 75 (5): 788–790. doi:10.1148/75.5.788. ISSN 0033-8419.
- ↑ Hammond DI (March 1984). "The "ring-around-the-artery" sign in pneumomediastinum". J Can Assoc Radiol. 35 (1): 88–9. PMID 6725378.
- ↑ Levin, Bertram (1973). "The continuous diaphragm sign". Clinical Radiology. 24 (3): 337–338. doi:10.1016/S0009-9260(73)80050-9. ISSN 0009-9260.
- ↑ Lillard, Richard L.; Allen, Parker (1965). "The Extrapleural Air Sign in Pneumomediastinum". Radiology. 85 (6): 1093–1098. doi:10.1148/85.6.1093. ISSN 0033-8419.
- ↑ Kouritas VK, Papagiannopoulos K, Lazaridis G, Baka S, Mpoukovinas I, Karavasilis V, Lampaki S, Kioumis I, Pitsiou G, Papaiwannou A, Karavergou A, Kipourou M, Lada M, Organtzis J, Katsikogiannis N, Tsakiridis K, Zarogoulidis K, Zarogoulidis P (February 2015). "Pneumomediastinum". J Thorac Dis. 7 (Suppl 1): S44–9. doi:10.3978/j.issn.2072-1439.2015.01.11. PMC 4332083. PMID 25774307.
- ↑ Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE (September 2008). "Spontaneous pneumomediastinum: a comparative study and review of the literature". Ann. Thorac. Surg. 86 (3): 962–6. doi:10.1016/j.athoracsur.2008.04.067. PMID 18721592.
- ↑ Perna V, Vilà E, Guelbenzu JJ, Amat I (March 2010). "Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients". Eur J Cardiothorac Surg. 37 (3): 573–5. doi:10.1016/j.ejcts.2009.08.002. PMID 19748792.
- ↑ Iyer VN, Joshi AY, Ryu JH (May 2009). "Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients". Mayo Clin. Proc. 84 (5): 417–21. doi:10.1016/S0025-6196(11)60560-0. PMC 2676124. PMID 19411438.