The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Pneumomediastinum Associated
with Influenza A Infection
A B

A
previously healthy 33-year-old man presented to the emergency Christopher T. Mansbridge,
department with a 10-day history of lethargy and feeling unwell. His tem- M.B., Ch.B.
perature was 38.3°C, and he had tachycardia, with an oxygen saturation of Matthew Inada-Kim, M.B., B.S.
85% while breathing 15 liters of oxygen per minute through a nonrebreather mask. Hampshire Hospitals NHS Foundation Trust
The physical examination was notable for bronchial breath sounds in the left Winchester, United Kingdom
lower lung; no subcutaneous emphysema was palpated. Chest radiography showed cmansbridge@doctors.org.uk
perihilar opacities in both lungs with free air in the mediastinum (Panel A, arrows).
Computed tomography confirmed pneumomediastinum (Panel B, arrows) with
enhanced interstitial markings and lower-lobe opacities in both lungs, with greater
severity in the left lung. The throat swab was positive for influenza A (H1N1). The
patient received noninvasive ventilatory support and was treated with zanamivir for
influenza and piperacillin–tazobactam for bacterial superinfection. The pneumo-
mediastinum resolved without additional intervention, and the patient was dis-
charged from the hospital 15 days after presentation.
DOI: 10.1056/NEJMicm1702849
Copyright © 2017 Massachusetts Medical Society.

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