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Spontaneous Pneumomediastinum

Mack EKM - MedPix (2015)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Spontaneous Pneumomediastinum

History: This 18 year-old male U.S. Marine Corps recruit presented to the ED with "bubbles under his skin" and a sudden change in his voice. Over the last few hours, he reports an acute decrease in exercise tolerance and he now becomes short of breath with minimal exertion. He first appreciated the bubbles, which are primarily along his upper chest and the base of his neck, after he suddenly felt pain in the area while bending forward. Additionally, he endorses pain with swallowing as well as epigastric pain. He denies any trauma, recent illness, nausea, vomiting, or shortness of breath at rest. Of note, he does report that he has been "screaming a lot" during his training. The patient has no past medical or surgical history, takes no medications and has no allergies. He does not consume alcohol, use tobacco or illicit drugs. He currently is in the first week of USMC recruit training and lives in the barracks.

Findings: Chest X-Ray: Lung fields are clear. There is mediastinal air present. Pleural margins show a small apical pneumothorax on the left and a trace apical pneumothorax on the right. Diffuse subcutaneous emphysema along anterior chest and both sides, as well as in the soft tissues of the neck. There is also intraperitoneal and retroperitoneal free air.

Ddx: • Tracheobronchial Perforation • Esophageal Perforation • Traumatic Pneumomediastinum • Spontaneous Pneumomediastinum • Pneumothorax • Necrotizing Soft Tissue Infection

Dxhow: Imaging and clinical followup

Exam: Vitals: HR 72, BP 138/79, RR 20, SpO2 99% RA, T 98.5 oral The patient is alert and oriented x 4 and in no acute distress on presentation, however his voice is notably hoarse. His head is atraumatic and his oral mucosa is moist. Neck is atraumatic with trachea midline and no apparent JVD. Subcutaneous emphysema is palpated along the anterior chest wall without any evidence of bony deformity or signs of trauma. Lungs are clear and equal bilaterally in all fields. Cardiac exam reveals a regular rate and rhythm without murmurs, rubs, or gallops. Abdomen is soft, non-distended, and mildly tender to palpation over the epigastrum without peritoneal signs. Bowel sounds are normoactive. His extremities exhibit no peripheral edema or signs of trauma. Labs: WBC 13.9, Hgb 13.7, Hct 40.6, Plt 230, Na 139, K 3.7, Cl 99, CO2 26, BUN 14, Cr 0.7, Glu 77, Ca 9.4, Mg 2.1, PO4 3.0

No MeSH data available.


Lung fields are clear. There is mediastinal air present. Pleural margins show a small apical pneumothorax on the left and a trace apical pneumothorax on the right. Diffuse subcutaneous emphysema along anterior chest and both sides, as well as in the soft tissues of the neck. There is also intraperitoneal and retroperitoneal free air.
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MPX2122_synpic61186: Lung fields are clear. There is mediastinal air present. Pleural margins show a small apical pneumothorax on the left and a trace apical pneumothorax on the right. Diffuse subcutaneous emphysema along anterior chest and both sides, as well as in the soft tissues of the neck. There is also intraperitoneal and retroperitoneal free air.


Spontaneous Pneumomediastinum

Mack EKM - MedPix (2015)

Lung fields are clear. There is mediastinal air present. Pleural margins show a small apical pneumothorax on the left and a trace apical pneumothorax on the right. Diffuse subcutaneous emphysema along anterior chest and both sides, as well as in the soft tissues of the neck. There is also intraperitoneal and retroperitoneal free air.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2122&req=5

MPX2122_synpic61186: Lung fields are clear. There is mediastinal air present. Pleural margins show a small apical pneumothorax on the left and a trace apical pneumothorax on the right. Diffuse subcutaneous emphysema along anterior chest and both sides, as well as in the soft tissues of the neck. There is also intraperitoneal and retroperitoneal free air.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Spontaneous Pneumomediastinum

History: This 18 year-old male U.S. Marine Corps recruit presented to the ED with "bubbles under his skin" and a sudden change in his voice. Over the last few hours, he reports an acute decrease in exercise tolerance and he now becomes short of breath with minimal exertion. He first appreciated the bubbles, which are primarily along his upper chest and the base of his neck, after he suddenly felt pain in the area while bending forward. Additionally, he endorses pain with swallowing as well as epigastric pain. He denies any trauma, recent illness, nausea, vomiting, or shortness of breath at rest. Of note, he does report that he has been "screaming a lot" during his training. The patient has no past medical or surgical history, takes no medications and has no allergies. He does not consume alcohol, use tobacco or illicit drugs. He currently is in the first week of USMC recruit training and lives in the barracks.

Findings: Chest X-Ray: Lung fields are clear. There is mediastinal air present. Pleural margins show a small apical pneumothorax on the left and a trace apical pneumothorax on the right. Diffuse subcutaneous emphysema along anterior chest and both sides, as well as in the soft tissues of the neck. There is also intraperitoneal and retroperitoneal free air.

Ddx: • Tracheobronchial Perforation • Esophageal Perforation • Traumatic Pneumomediastinum • Spontaneous Pneumomediastinum • Pneumothorax • Necrotizing Soft Tissue Infection

Dxhow: Imaging and clinical followup

Exam: Vitals: HR 72, BP 138/79, RR 20, SpO2 99% RA, T 98.5 oral The patient is alert and oriented x 4 and in no acute distress on presentation, however his voice is notably hoarse. His head is atraumatic and his oral mucosa is moist. Neck is atraumatic with trachea midline and no apparent JVD. Subcutaneous emphysema is palpated along the anterior chest wall without any evidence of bony deformity or signs of trauma. Lungs are clear and equal bilaterally in all fields. Cardiac exam reveals a regular rate and rhythm without murmurs, rubs, or gallops. Abdomen is soft, non-distended, and mildly tender to palpation over the epigastrum without peritoneal signs. Bowel sounds are normoactive. His extremities exhibit no peripheral edema or signs of trauma. Labs: WBC 13.9, Hgb 13.7, Hct 40.6, Plt 230, Na 139, K 3.7, Cl 99, CO2 26, BUN 14, Cr 0.7, Glu 77, Ca 9.4, Mg 2.1, PO4 3.0

No MeSH data available.