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Question
50 yo female s/p motor vehicle crash. Diagnosis?
Answer
Answer: Pneumomediastinum from pneumothorax
Pneumomediastinum
Mediastinal air has multiple causes:
- Intrathoracic injury (e.g., Pneumothorax)
- Upper respiratory tract (e.g., Injury during intubation)
- Digestive tract perforation (e.g., Boerhaave’s syndrome)
- Intra-abdominal perforation (e.g., EGD complication)
- Anaerobic infection at sites communicating with mediastinum
- Ludwig’s angina
- Pneumoperitoneum
- Bacterial mediastinitis
Listen for Hamman's sign ("crunching" with cardiac auscultation) and feel for crepitus (distinct feeling on palpation).
Treat the precipitating cause.
Usually resolves without mediastinal decompression; air travels along tissue planes decompressing increased mediastinal pressure.
