Continuous Diaphragm Sign Research Articles

Spontaneous pneumomediastinum and surgical emphysema presenting as rhinolalia following ecstasy ingestion: a case report

BackgroundWe present a unique case of rhinolalia as the first recognizable sign of spontaneous pneumomediastinum and surgical emphysema following drug use.Case presentationThis case presents a 17-year-old white male experiencing rhinolalia following ecstasy ingestion at a rave. Subsequent chest X-ray revealed extensive surgical emphysema, along with a continuous diaphragm sign indicative of pneumomediastinum. Computed tomography confirmed the diagnosis. The patient was managed conservatively with strict monitoring and 6 hourly electrocardiograms. Follow-up computed tomography on day 3 showed resolution of pneumomediastinum and surgical emphysema, and the patient was safely discharged. Notably, the patient experienced a temporary rhinolalia during the acute phase, which resolved spontaneously as his condition improved.ConclusionsThis case underscores the importance of considering spontaneous pneumomediastinum and surgical emphysema in the differential diagnosis of young individuals presenting with acute symptoms after drug use.

Continuous Diaphragm Sign

Continuous Diaphragm Sign

The Sign of Continuity: Continuous Diaphragm Sign in Pneumoperitoneum

The continuous diaphragm sign is a radiological sign seen on either upright or supine views of chest radiographs as reported by Levin (Clin Radiol 24:337–338, 1973). It is indicative of pneumomediastinum or pneumopericardium if radiolucency is present above the diaphragm, or of pneumoperitoneum if radiolucency is present below the diaphragm. Pneumoperitoneum, defined as the presence of free air in the peritoneal cavity, rarely presents with the continuous diaphragm sign on the radiographs as noted by Wu et al. (J Acute Med 3:20–22, 2013).

SPONTANEOUS PNEUMOMEDIASTINUM AFTER RUNNING SPRINT

SESSION TITLE: Disorders of the Mediastinum 1 SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/08/2018 03:15 pm - 04:15 pm INTRODUCTION: spontaneous pneumomediastinum is a rare self limiting clinical entity presents with free air in mediastinum without external injury.it presents mostly in young male.it occurs because of alveolar rupture and air seeping into lung interstitial tissue and reaches mediastinum through hilum.it is diagnosed by chest X-ray and CT (computed tomography) chest. if esophageal rupture is ruled out then the management is conservative. CASE PRESENTATION: 17 year old male presented with history of breathlessness and crepitus sensation felt around neck.clinically he was alert and oxygen saturation was 98% in room air ,with BP 120/80 , pulse rate 76/min and respiratory rate 18/min. he had subcutaneous emphysema around neck.he was not an asthmatic but had a history of 100 meter running race a day before these symptoms occurred . his computed tomography showed air in mediastinum.he was managed conservatively. DISCUSSION: spontaneous pneumomediastinum is a rare self limiting condition usually occurring in young male.it happens when there is increase in intra-alveolar pressure.this pressure makes the alveoli rupture and air seeps through intertitium,hilum and reaches mediastinum. causes of increased alveolar pressure are asthmatic, mechanical ventilation, coughing,blunt injury and valsalva maneuver .patient usually presents chest pain, breathlessness neck crepitus and hamman's sign ( a mediastinal crunching sound synchronized with systole).xray chest shows prominent aortic knob, continuous diaphragm sign and subcutaneous emphysema but these findings are usually missed.computed tomography is more sensitive in detecting air in mediastinum .conservative treatment is the line of management.in this case the individual gone for 100 meter sprint a day before spontaneous pneumomediastinum and he had no other cause for pneumomediastinum.few case reports of spontaneous pneumomediastinum after sprints has been reported (1). CONCLUSIONS: spontaneous pneumomedistinum is a rare clinical entity occurring in young individuals without underlying cause.it can also occur in sprinters .conservative treatment is the treatment of choice. Reference #1: spontaneous pneumomediastinum from running sprints.Turban JW case rep med 2010:2010.pii:927467.Epub2010 sep 2 DISCLOSURES: No relevant relationships by saravanan mariappan, source=Web Response

Pleural Effusions and Pneumothoraces.

1. Katherine Cashen, DO* 2. Tara L. Petersen, MD† 1. *Department of Pediatrics, Children's Hospital of Michigan/Wayne State University School of Medicine, Detroit, MI 2. †Division of Critical Care, Department of Pediatrics, The Children’s Hospital of Wisconsin/The Medical College of Wisconsin, Milwaukee, WI * Abbreviations: BTS: : British Thoracic Society CHF: : congestive heart failure CT: : computed tomography VATS: : video-assisted thoracoscopic surgery 1. Clinicians should be aware of the causes and clinical presentation of pleural effusions and pneumothoraces. 2. Clinicians should understand the current role of diagnostic tests, imaging modalities, and timing of minimally invasive treatments. After completing this article, readers should be able to: 1. Describe the pathogenesis of pleural fluid accumulation. 2. Identify the most likely causes of pleural effusion and pneumothorax. 3. Understand the basic clinical presentation, diagnostic tests, and management of pleural effusions and pneumothoraces. 4. Differentiate between transudative and exudative pleural effusions. 5. Understand the natural history of spontaneous pneumothorax. The pleural space is created by the parietal and visceral pleura that line the chest wall and the lung surface, respectively. Normally, only a small amount (0.3 mL/kg) of hypotonic fluid is present within the pleural space due to homeostatic balances in physiologic fluid production and absorption. Various infectious and noninfectious processes can lead to pathologic filling of the pleural space with fluid (effusion) or air (pneumothorax). Such pathologic changes create a true space that can interfere with normal lung mechanics and, in severe cases, cardiac function. Although much less common in pediatric than adult populations, pleural effusions and pneumothoraces in both groups can lead to substantial complications, resulting in significant morbidity and mortality if unrecognized or untreated. Overall, the cause of pleural effusions and pneumothoraces differs in children compared to adults. In adults, congestive heart failure (CHF) and malignancy account for a substantial number of pleural effusions, but these are uncommon causes in children. Infectious pleural effusions in the setting of pneumonia (parapneumonic effusions) remain the most common cause of effusions in both children and adults. Unlike the adult population, children experience spontaneous …

An unusual cause of acute cor pulmonale – Significance of the ‘continuous diaphragm sign’

A patient presented with chest pain and clinical features of acute right heart failure. Initial work up revealed the presence of severe PAH. Acute pulmonary embolism is the commonest and most life-threatening cause for acute cor pulmonale. Even though the clinical picture suggested pulmonary embolism, a subtle sign was missed from the first chest X-ray taken in the emergency department. However on reanalysis the ‘continuous diaphragm sign’ later guided us towards the diagnosis. Our case represents one of the first reports of a rare etiology for acute cor pulmonale – hypersensitivity pneumonitis. Right ventricular dysfunction was caused by an acute rise in pulmonary artery pressures as well as by the compressive effects of pneumomediastinum. We emphasize the role played by a good quality chest X-ray early in the management of acute chest pain syndromes. However pulmonary embolism should be ruled out conclusively before redirecting attention to less malignant conditions.

Continuous diaphragm sign in amyopathic dermatomyositis

Continuous diaphragm sign in amyopathic dermatomyositis

Continuous Diaphragm Sign

An 11-year-old female presented to the emergency department with fever of 1 day's duration and sore throat. Her family described a 3-week history of cough with fever, trouble breathing, and wheezing. Her medical history included panhypopituitarism and asthma, and she was receiving steroid replacement therapy. She had recently undergone a dental extraction. Examination showed a temperature of 39.5°C, a 3/6 systolic murmur, bibasilar rales, and palpable cervical subcutaneous emphysema. On chest radiograph, the diaphragm appeared continuous and was not obscured by the inferior heart border (Figure 1). A computed tomography scan demonstrated the same finding (Figure 2). Figure 1 Frontal chest radiograph. The diaphragm is not obscured by the inferior heart border (black arrows). Figure 2 Coronal reconstruction of chest computed tomography scan demonstrates a clear space between the heart and diaphragm (black arrows). The images depict a “continuous diaphragm sign,” an infrequent indicator of pneumomediastinum.1 It is seen on a frontal radiograph when gas in the mediastinum separates the heart and the superior surface of the diaphragm, and it can be seen on either upright or supine views.1,2 A continuous diaphragm may also be seen with pneumopericardium, although it is much less common.3,4 Distinguishing the 2 conditions radiographically can be challenging, but pneumopericardium typically appears as an isolated broad band around the heart rather than the multiple thin lucent streaks extending into neck seen with pneumomediastinum.3 Pneumomediastinum occurs after alveolar rupture as gas travels along the bronchovascular interstitial sheaths into the mediastinum.3,5 Nontraumatic causes include invasive procedures and mechanical ventilation, airway obstruction, barotrauma, and pulmonary or pericardial infections, and it has also been described after dental extractions.3–6 Spontaneous pneumomediastinum is rare and usually benign, and tends to occur in males and younger patients.7,8 Common symptoms of pneumomediastinum are chest pain and dyspnea, and signs are subcutaneous emphysema, wheezing, and Hammon sign.3,7,8 Differential diagnoses include pneumothorax and esophageal rupture, and complications include hypotension from impaired venous return, tension pneumothorax, and cardiac tamponade.3,4,7 Most cases follow a benign course and require no therapy, although in 1 series prophylactic antibiotics were given and all cases resolved without complication.8

"Continuous Diaphragm Sign" After Endotracheal Intubation

"Continuous Diaphragm Sign" After Endotracheal Intubation

Signs in chest imaging: a pictorial review

A radiological sign can sometimes resemble a particular object or pattern and is often highly suggestive of a group of similar pathologies. Awareness of such similarities can shorten the differential diagnosis list. Many such signs have been described for X-ray and computed tomography (CT) images. In this article, we present the most frequently encountered plain film and CT signs in chest imaging. These signs include for plain films the air bronchogram sign, silhouette sign, deep sulcus sign, Continuous diaphragm sign, air crescent ("meniscus") sign, Golden S sign, cervicothoracic sign, Luftsichel sign, scimitar sign, doughnut sign, Hampton hump sign, Westermark sign, and juxtaphrenic peak sign, and for CT the gloved finger sign, CT halo sign, signet ring sign, comet tail sign, CT angiogram sign, crazy paving pattern, tree-in-bud sign, feeding vessel sign, split pleura sign, and reversed halo sign.

Spontaneous Pneumomediastinum in Children

Spontaneous pneumomediastinum (SPM) is a rare, generally benign condition in young children caused by alveolar rupture and dissection of air into the mediastinum and hilum. In children, SPM is seen most commonly in asthmatics but may also occur in any patient who induces a Valsalva maneuver, including coughing, forceful vomiting, or first-time wheezing. There are limited reports on SPM in first-time wheezing episodes. We report a case of a 4-year-old girl with no history of wheezing who presents with wheezing, mild respiratory distress, and salient radiographic findings of pneumomediastinum, including spinnaker sail sign and continuous diaphragm sign. The SPM is generally a benign entity that requires supportive care, and resolution occurs spontaneously. This article will allow the clinician to become familiar with the specific clinical and radiological signs associated with SPM.

Pneumomediastinum revisited.

Pneumomediastinum may result from a variety of causes that may be either intrathoracic (eg, narrowed or plugged airway, straining against a closed glottis, blunt chest trauma, alveolar rupture) or extrathoracic (eg, sinus fracture, iatrogenic manipulation in dental extraction, perforation of a hollow viscus [corrected]. The radiographic signs of pneumomediastinum depend on the depiction of normal anatomic structures that are outlined by the air as it leaves the mediastinum. These signs include the thymic sail sign, "ring around the artery" sign, tubular artery sign, double bronchial wall sign, continuous diaphragm sign, and extrapleural sign. In distal esophageal rupture, air may migrate from the mediastinum into the pulmonary ligament. Pneumomediastinum may be difficult to differentiate from medial pneumothorax and pneumopericardium. Occasionally, normal anatomic structures (eg, major fissure, anterior junction line) may simulate air within the mediastinum. Iatrogenic entities that may simulate pneumomediastinum include helium in the balloon of an intraaortic assist device. In addition, pneumomediastinum may be simulated by the Mach band effect, which manifests as a region of lucency adjacent to structures with convex borders. The absence of an opaque line, which is typically seen in pneumomediastinum, can aid in differentiation. Computed tomographic (CT) digital radiography and conventional CT can also be helpful in establishing or confirming the diagnosis.

Pneumomediastinum: old signs and new signs.

Pneumomediastinum, also known as mediastinal emphysema, represents extraluminal gas in the mediastinum. Pneumomediastinum can lead to pneumothorax, pneumopericardium, pneumoperitoneum, or pneumoretroperitoneum. There are many causes of pneumomediastinum (Table 1) and several radiographic signs: pneumopericardium, continuous diaphragm sign, continuous left hemidiaphragm sign, Naclerio's V sign, V sign at confluence of brachiocephalic veins, ring-around-the-artery sign, thymic spinnaker-sail sign, and extrapleural air sign. We review the common and uncommon signs of pneumomediastinum and present some new signs. We also address the problem of distinguishing pneumomediastinum from pneumothorax and pneumopericardium.

Letter: Continuous diaphragm sign of pneumomediastinum.

Letter: Continuous diaphragm sign of pneumomediastinum.

The continuous diaphragm sign: A newly-recognized sign of pneumomediastinum

Attention is called to a radiological finding noted in some cases of pneumomediastinum. It is the interposition of air between the heart and the diaphragm on a frontal radiograph, permitting visualization of the central portion of the diaphragm in continuity with the lateral portions. The author refers to this as “the continuous diaphragm sign”. Its identification and its differentiation from pneumopericardium is discussed. Attention is called to a radiological finding noted in some cases of pneumomediastinum. It is the interposition of air between the heart and the diaphragm on a frontal radiograph, permitting visualization of the central portion of the diaphragm in continuity with the lateral portions. The author refers to this as “the continuous diaphragm sign”. Its identification and its differentiation from pneumopericardium is discussed.