PNEUMOMEDIASTINUM

Def: free air/gas within the mediastinum

Gas origin:
Intrathoracic

Trachea, bronchi
Esophagus
Lungs
Pleural space

Extrathoracic
Head & neck injury
Retroperitoneum

Can lead to pneumothorax,

pnemopericardium, pneumoperitoneum

RADIOLOGICAL FEATURES
Subcutaneous emphysema
Hyperlucent lines enhancing mediastinal
viscera & outline lateral heart borders
Continuous diaphragm sign
Ring-around-pulmonary-artery sign
Thymic/spinnaker sail sign
Naclerios V sign
Tubular artery sign
pneumopericardium
Extrapleural sign

Subcutaneous emphysema
Lucencies overlying the
shoulder and upper chest
(blue circle)
Red arrow: supraclavicular
emphysema
White arrow: air in
mediastinum

Enhancement on mediastinal
structures
Enhancement of heart borders

Air outlining ascending

Continuous diaphragm sign

Ring around pulmonary

artery sign

Lucent ring around pulmonary artery

Thymic/Spinnaker sail sign

thymus separated from

mediastinal structures

Naclerios V sign

Air outlining the

descending aorta
intersects with air
outlining the left
hemidiaphragm

Tubular artery sign

Air
outlining
left
subclavian
artery &
left
carotid
artery

Pneumopericardium

Air
between
sternum &
heart

Extrapleural sign

Air outlining the

left
hemidiaphragm

CT Scan

Air in supra-aortic, sub-aortic & para-cardiac mediastinum

Air within mediastinum (white arrows)

Subcutaneous emphysema (black
arrows)

PULMONARY CONTUSION
Def: injury to the lung parenchyma
without laceration (blunt trauma)
often occur in small children in the
absence of fractures due to the high
compliance of the chest wall.
a/w bruising, ribs #, flail chest
Pathology:
Hemorrhage into the lung parenchyma
produces airspace disease

Plain radiograph
Features seen within 6 hours after trauma
Not sensitive, low clinical value
Faint patchy consolidative regions following
history of blunt trauma.

Usually shows rapid improvement with

time, signs of contusion have often
resolved within 48 hours
If consolidation > 72 hours, consider:
Aspiration
ARDS
Pneumonia

Blue: alveolar opacities

Red: associated ribs #

CT Scan
Most
sensitive

Red: evidence of
pulmonary contusion
Blue: rib #

Typically
seen as
focal, non
segmental
(typically
crescentic)
areas of
parenchymal