Pneumomediastinum

What is it: presence of extraluminal gas within the mediastinum. Gas may originate from the lungs, trachea,
central bronchi, esophagus, and peritoneal cavity and track from the mediastinum to the neck or abdomen

How does it present: streaky

lucencies over the mediastinum that extend into the
neck,  and elevation of the parietal pleura along the mediastinal borders

Subcutaneous emphysema (vertical lucent stripes into neck) and

"double bronchial wall sign" suggesting pneumomediastinum. Small rim of air at AP window
 Lack of lung markings particularly on R side, suggesting widened
mediastinum filled with air. Note: compressed lung on the lower R (increased radio-opacity).

Very extensive pneumomediastium is demonstrated

throughout the chest with no pneumothorax

Mild pneumomediastinum with air outlining the

left mediastinal border, azygoesophageal recess and tracking up into the superior paratracheal space
 Large amount
of air noted in the anterior and middle mediastinum especially in the right paracardiac region. features are
suggestive of pneumomediastinum. There is evidence of a large pneumothorax on the right side

Frontal and lateral radiographs

reveal pnemomediastinum (black arrows).   Note is also made of subcutaneous emphysema (red arrow) along
the chest wall, more prominent along the right than left
 presence of air in the
mediastinum (red arrows) and subcutaneous emphysema (yellow arrows)

Pneumothorax

What is it: It is the presence of gas (air) in the pleural space. When this collection of gas is constantly
enlarging with resulting compression of mediastinal structures, it can be life-threatening and is known as
a tension pneumothorax. If no tension is present it is a simple pneumothorax. A primary spontaneous
pneumothorax is one which occurs in a patient with no known underlying lung disease. When the
underlying lung is abnormal, a pneumothorax is referred to as secondary spontaneous.

How does it present: Presentation is variable and may range from no symptoms to severe dyspnea with
tachycardia and hypotension. In patients who have a tension pneumothorax, presentation may be with
distended neck veins and tracheal deviation, cardiac arrest and in the most severe cases, death
 Left sided pneumothorax from rupture of apical blebs

Left
upper lobe collapse. No mediastinal shift

Moderate sized left pneumothorax with a deep costophrenic angle

(pediatric patient)
 Arrows show the
pleura. Also seen is an acute clavicular fracture on the right. No rib fractures are seen though there may
be an occult one. Inspiratory vs expiratory phases

Right-sided pneumothorax and fracture of
ribs 8-10.
 Signs of bullous
emphysema of apical predominance, and presence of right pneumothorax

right sided tension pneumothorax with right sided

lucency and leftward mediastinal shift
Tension pneumothorax on left (blue arrow) is displacing the heart and mediastinal structures to the
right (red arrow); this case also shows a deep sulcus sign on the left (yellow arrow). There is
underlying hyaline membrane disease