Pneumomediastinum Microchapters Home Patient Information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Pneumomediastinum from other Diseases Epidemiology and Demographics Risk Factors Screening Natural History, Complications and Prognosis Diagnosis Diagnostic Study of Choice History and Symptoms Physical Examination Laboratory Findings Electrocardiogram Chest X Ray MRI Echocardiography or Ultrasound Other Imaging Findings Other Diagnostic Studies Treatment Medical Therapy Surgery Primary Prevention Secondary Prevention Case Studies Case #1 Pneumomediastinum chest x ray On the Web Most recent articles Most cited articles Review articles CME Programs Powerpoint slides Images American Roentgen Ray Society Images of Pneumomediastinum chest x ray All Images X-rays Echo & Ultrasound CT Images MRI Ongoing Trials at Clinical Trials.gov US National Guidelines Clearinghouse NICE Guidance FDA on Pneumomediastinum chest x ray CDC on Pneumomediastinum chest x ray Pneumomediastinum chest x ray in the news Blogs on Pneumomediastinum chest x ray Directions to Hospitals Treating Pneumomediastinum Risk calculators and risk factors for Pneumomediastinum chest x ray Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2] ## Overview[edit | edit source] The diagnosis can be confirmed via chest X-ray showing a radiolucent outline around the heart and mediastinum or via CT scanning of the thorax. The presence of air within the connective tissue planes of the mediastinum can be seen on chest X-ray. ## Chest X Ray[edit | edit source] The following radiological finding(s) are associated with pneumomediastinum:[1][2][3][4][5][6][7] * Subcutaneous emphysema * Naclerio V sign * Seen in pneumomediastinum occurring often secondary to an oesophageal rupture but it is not entirely specific to that condition. * Pneumopericardium * Gas anterior to pericardium * Ring around artery sign * Gas around pulmonary artery and main branches * Tubular artery sign * Gas outlining major aortic branches * Double bronchial wall sign * Gas outlining bronchial wall * Continuous diaphragm sign * Gas trapped posterior to pericardium * Extrapleural sign * Gas between parietal pleura and diaphragm * Gas in pulmonary ligament Pediatric pneumomediastinum has different appearances: * Thymic wing sign * Elevated thymus * Haystack sign (the heart appears like a haystack in a Monet painting) * Gas crossing the superior mediastinum * Pneumomediastinum: Spinnaker sail sign (Image courtesy of RadsWiki) * Pneumomediastinum and right sided pneumothorax post first rib fracture in a mountain biking accident. ## References[edit | edit source] 1. ↑ Taveras, J., & Ferrucci, J. (1986). Radiology. Diagnosis/imaging/intervention. 5 volumes. Annual revision service. R. Health Professions,Philadelphia, PA. 2. ↑ 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. 3. ↑ 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. 4. ↑ Moseley, John E. (1960). "Loculated Pneumomediastinum in the Newborn". Radiology. 75 (5): 788–790. doi:10.1148/75.5.788. ISSN 0033-8419. 5. ↑ Hammond DI (March 1984). "The "ring-around-the-artery" sign in pneumomediastinum". J Can Assoc Radiol. 35 (1): 88–9. PMID 6725378. 6. ↑ Levin, Bertram (1973). "The continuous diaphragm sign". Clinical Radiology. 24 (3): 337–338. doi:10.1016/S0009-9260(73)80050-9. ISSN 0009-9260. 7. ↑ 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. Template:WH Template:WS