A. Pleural Effusion
B. Lung Collapse
Pneumomediastinum. Note the thin layer of air outlining the left cardiac and aortic contour (arrows) and subcutaneous emphysema in the lower neck (arrowheads).
- Which is most likely due to recent oesophageal perforation by fish bone
- Other radiological findings of pneumomediastinum not seen in this patient include:
- Continuous diaphragm sign – continuous radiolucency connecting both sides of diaphragm .
- V-sign of Naclerio – air between lower thoracic aorta and diaphragm
Air may leak into mediastinum via:
- Perforation of any air-containing viscus
- Pharynx/oesophagus (e.g. due to foreign body ingestion, instrumentation etc.)
- Leak from major or small intrapulmonary airways (e.g. asthma, excessive coughing etc.)
- Penetrating thoracic trauma with introduction of air from an external environment
- Water soluble contrast swallow may help to confirm the presence of oesophageal perforation
- CT is more sensitive in detecting small pneumomediastinum.
- CT thorax detects associated complications such as mediastinitis/mediastinal abscess