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CT Scan Files - Spontaneous pneumomediastinum  


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.

Submitted by : Academic division, 'MA' Advanced Diagnostic & Research Centre, AP. INDIA.

                              DR. M.ADINARAYANA RAO. MD.

                              DR. G.GOWRI SEKHAR . DNB.,DMRD.

                              DR. D. PRASAD REDDY. DMRD.

                              DR. M. REKHA. MBBS.,DGO., F.US & CD.

                              DR. ANWAR HUSSAIN.  MD.(GEN.).

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