Abstract
Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST) was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the “Mackling effect.” Sonographic findings consistent with pneumomediastinum, like the “air gap” sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.
Highlights
Pneumomediastinum is defined as presence of air or other gases in the mediastinum and is known as mediastinal emphysema
In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river
Sonographic findings consistent with pneumomediastinum, like the “air gap” sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal extended Focused Assessment with Sonography for Trauma (e-FAST) a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma
Summary
Pneumomediastinum is defined as presence of air or other gases in the mediastinum and is known as mediastinal emphysema. Pneumomediastinum may result from any of the following four anatomic mechanisms: first, by direct air leak from rupture of the larynx, trachea, bronchus, or esophagus into the mediastinum; second, by the “Macklin effect,” first described by Macklin in 1939 [1], who reported that a sudden increase in intrathoracic pressure results in an increased intra-alveolar pressure, leading to alveolar rupture, with air dissection along bronchovascular sheaths, and the spreading of this pulmonary interstitial emphysema into the mediastinum. Traumatic pneumomediastinum is caused by blunt in around 86% or penetrating trauma in around 14% of cases [3] or by iatrogenic injury, such as that produced by mechanical ventilation or endoscopic procedures [4]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
