• boerhaave syndrome
• esophageal rupture after vomiting
• esophageal rupture treatment
• nonoperative management of rupture
• spontaneous esophageal rupture

• Coronavirus disease-2019
• Pneumomediastinum
• Pneumothorax
• Respiratory support

• Humans
• Infant, Newborn
• Radiography, Thoracic/methods
• Diagnostic Imaging/methods

• Humans
• Imaging, Three-Dimensional
• Radiography
• Radiography, Thoracic
• Tomography, X-Ray Computed

• Humans
• Diagnostic Imaging
• Communication
• Databases, Factual
• Radiologists

• P30 CA008748 NCI NIH HHS

• Children patients
• pneumomediastinum
• pneumothorax.

• Blowout fracture
• Cat
• Chemotherapy
• Lymphoma
• Pneumomediastinum

• Male
• Cats
• Animals
• Mediastinal Emphysema/etiology
• Mediastinal Emphysema/veterinary
• Fractures, Spontaneous/veterinary
• Nose
• Subcutaneous Emphysema/etiology
• Subcutaneous Emphysema/veterinary
• Lymphoma, T-Cell/veterinary
• Lymphoma, T-Cell, Peripheral/veterinary
• Cat Diseases/etiology

• Acute respiratory distress syndrome
• Barotrauma
• Macklin effect
• Mechanical ventilation
• Pneumomediastinum
• Pneumothorax

• Humans
• Child
• Thoracic Injuries/complications
• COVID-19/complications
• Wounds, Nonpenetrating/complications
• Respiratory Distress Syndrome/diagnostic imaging
• Respiratory Distress Syndrome/etiology
• Barotrauma/complications
• Barotrauma/epidemiology
• Respiration, Artificial/adverse effects

• case series
• foreign body aspiration
• pneumomediastinum
• saudi arabia

• Bronchi/diagnostic imaging
• Bronchoscopy/adverse effects
• Child
• Female
• Foreign Bodies/surgery
• Humans
• Inhalation
• Male
• Mediastinal Emphysema/diagnostic imaging
• Mediastinal Emphysema/etiology
• Pneumothorax/diagnostic imaging
• Pneumothorax/etiology
• Pneumothorax/therapy

To investigate the incidence, risk factors, and outcomes of barotrauma (pneumomediastinum and subcutaneous emphysema) in mechanically ventilated COVID-19 patients. To describe the chest radiography patterns of barotrauma and understand the development in relation to mechanical ventilation and patient mortality.

We performed a retrospective study of 363 patients with COVID-19 from March 1 to April 8, 2020. Primary outcomes were pneumomediastinum or subcutaneous emphysema with or without pneumothorax, pneumoperitoneum, or pneumoretroperitoneum. The secondary outcomes were length of intubation and death. In patients with pneumomediastinum and/or subcutaneous emphysema, we conducted an imaging review to determine the timeline of barotrauma development.

Forty three out of 363 (12%) patients developed barotrauma radiographically. The median time to development of either pneumomediastinum or subcutaneous emphysema was 2 days (IQR 1.0–4.5) after intubation and the median time to pneumothorax was 7 days (IQR 2.0–10.0). The overall incidence of pneumothorax was 28/363 (8%) with an incidence of 17/43 (40%) in the barotrauma cohort and 11/320 (3%) in those without barotrauma (p ≤ 0.001). In total, 257/363 (71%) patients died with an increase in mortality in those with barotrauma 33/43 (77%) vs. 224/320 (70%). When adjusting for covariates, barotrauma was associated with increased odds of death (OR 2.99, 95% CI 1.25–7.17).

Barotrauma is a frequent complication of mechanically ventilated COVID-19 patients. In comparison to intubated COVID-19 patients without barotrauma, there is a higher rate of pneumothorax and an increased risk of death.

COVID-19 is a health crisis that triggered the need to find a rapid and sensitive tool to screen populations with a high risk of complications. Lactate dehydrogenase (LDH) is an enzyme found in almost all body cells, particularly pneumocytes, and appears to be associated with worst outcome. Pneumomediastinum (PM), which results from ruptured alveoli, can occur in non-ventilated patients. Acute pneumocytes injury induces the release of serum LDH.

This study evaluates the role of baseline serum LDH levels in predicting COVID-19 lung necrosis.

This retrospective study was conducted among 524 COVID-19 patients admitted to Hôtel-Dieu de France university hospital, Lebanon, between March 2020 and March 2021. Baseline serum LDH was retrieved from patients’ medical records. Radiological severity outcomes were assessed at admission and during follow-up by non-contrast computed tomography (NCCT) of the chest.

The mean age of participants was 63 ± 16 years, with 359 males (68.5%) and median (IQR) LDH levels upon admission of 328 (248–430). LDH was correlated with lobar involvement at both admission and NCCT follow-up (Spearman’s rho 0.527 and 0.264, respectively) and the development of a PM (p = 0.035) in 3% of the patients. Using ROC analysis, a baseline LDH value higher than 395 U/L was associated with the presence of a PM on admission and follow-up chest CT, with a sensitivity of 75% and a specificity of 60.1%.

Baseline LDH levels could serve as a tool for early diagnosis of severe pulmonary injury with poor radiological outcomes in hospitalized COVID-19 patients.

• ARDS
• COVID-19
• intensive care
• lung CT
• mechanical intubation
• pneumomediastinum
• pneumothorax
• pulmonary embolism
• superinfection

• Complications
• EBUS-TBNA
• Pneumomediastinum

The SARS-CoV-2 can cause severe pneumonia and highly impact general health. We aimed to investigate different clinical features and CT scan findings of patients with COVID-19 based on disease severity to have a better understanding of this disease.

Ninety patients with coronavirus were divided into three categories based on the severity of the disease: mild/moderate, severe, and very severe. Clinical, laboratory, and CT scan findings of the patients were examined retrospectively. Any association between these features and disease severity was assessed.

The mean age and duration of hospitalization of patients increased with increasing the severity of the disease. The most common clinical symptoms were shortness of breath, cough, and fever. As the severity of the disease increased from mild/moderate to very severe, there was an increase in neutrophil counts and a decrease in lymphocytes and white blood cells (WBC) showing excessive inflammation associated with severe forms of COVID-19. Subpleural changes (81%) and ground-glass opacification/opacity (GGO) lesions (73%) of the lung were the most common features in CT images of COVID-19 patients, and interlobular septal thickening (10%) was the lowest CT feature among patients. Regarding the affected parts of the lung in COVID-19 patients, bilateral, peripheral, and multiple lesions had the highest prevalence.

It has been shown that clinical, laboratory, and CT scan findings varied in COVID-19 patients based on disease severity, which need to be considered carefully in timely diagnosis and treatment of this illness.

• covid-19
• computed tomography
• sars-cov-2
• acute respiratory disease
• pneumonia
• clinical features

• ARDS
• Acute respiratory distress syndrome
• Complications of mechanical ventilation
• Covid-19 ARDS
• Endotracheal intubation
• Pneumomediastinum
• Pneumothorax

• COVID-19
• Humans
• Oxygen Saturation
• Respiration, Artificial/adverse effects
• Respiratory Distress Syndrome/diagnostic imaging
• Respiratory Distress Syndrome/therapy
• SARS-CoV-2

• UL1 TR001863 NCATS NIH HHS

• covid-19
• high flow nasal canula
• non-invasive mechanical ventilation
• pneumomediastinum
• pneumothorax (ptx)
• sars-cov-2

• Coronavirus disease 2019
• barotrauma
• intubation
• pneumomediastinum
• pneumothorax

Tracheal and bronchial diverticula are outpouchings arising from the trachea or bronchus. We present a case of a 35-year-old female who presented to the emergency department following a motor vehicle accident and was found to have multiple round, air-filled structures within the mediastinum on computed tomography of the thorax, concerning for pneumomediastinum. The patient had a negative fluoroscopic esophagography and subsequent imaging indicated tracheal and bronchial diverticula. While they are often asymptomatic and incidentally found, tracheal and bronchial diverticula may be misdiagnosed as pneumomediastinum, especially in the setting of blunt or penetrating trauma to the thorax.

• Bronchial diverticulum
• Computed tomography
• Emergency radiology
• Pneumomediastinum
• Tracheal diverticulum

• mediastinitis
• pediatrics
• pneumomediastinum
• spontaneous pneumomediastinum
• subcutaneous emphysema
• trauma

• Bronchopleural fistula
• Embolia venosa aérea
• Enfisema subcutáneo
• Esophageal perforation
• Fístula broncopleural
• Hernia intercostal transdiafragmática
• Neumomediastino
• Neumopericardio
• Neumotórax
• Perforación esofágica
• Pneumomediastina
• Pneumopericardium
• Pneumothorax
• Rotura traqueal
• Subcutaneous emphysema
• Tracheal rupture
• Transdiaphragmatic intercostal hernia
• Venous air embolism

• Humans
• Mediastinal Emphysema/diagnostic imaging
• Rupture
• Subcutaneous Emphysema/etiology
• Thorax
• Trachea

• COVID-19
• Pneumomediastinum
• Subcutaneous emphysema

• Adult
• Aged
• Aged, 80 and over
• Betacoronavirus
• COVID-19
• Comorbidity
• Coronavirus Infections/complications
• Coronavirus Infections/virology
• Female
• Fibrin Fibrinogen Degradation Products/metabolism
• Hospitalization
• Humans
• Male
• Mediastinal Emphysema/epidemiology
• Mediastinal Emphysema/etiology
• Middle Aged
• Pandemics
• Pneumonia, Viral/complications
• Pneumonia, Viral/virology
• Pneumothorax/epidemiology
• Pneumothorax/etiology
• Respiration, Artificial/adverse effects
• SARS-CoV-2
• Subcutaneous Emphysema/epidemiology
• Subcutaneous Emphysema/etiology
• Tomography, X-Ray Computed/methods

• CT
• Esophagography
• Esophagus
• Fluoroscopic
• Mediastinum
• Perforation
• Pneumomediastinum

•

Coronavirus Disease 2019 is a newly discovered viral disease whose knowledge is constantly evolving.

Spontaneous pneumomediastinum (SPM) and Loculated pneumothorax (LPNX) are both generally rare clinical and radiological conditions associated with Coronavirus Disease 2019 (COVID-19). We report for the first time clinical data and radiological chest CT imaging of two patients affected by COVID-pneumonia associated with early radiological findings of SPM and LPNX.

• COVID-19
• CT
• Loculated pneumothorax
• Spontaneous pneumomediastinum

• COVID-19
• acute respiratory distress syndrome
• pneumomediastinum
• surgical emphysema
• tracheal injury

• Air collection
• Computed tomography
• Intensive care unit
• Radiograph
• Thorax

Spontaneous pneumomediastinum in the term newborn is relatively rare. We aim to emphasize the significance of Radiographic and CT features of spontaneous pneumomediastinum. We present an otherwise healthy 4-hour-old male, born by a caesarean section, presenting with sudden bulging of the left hemithorax and moderate respiratory distress. Chest radiography revealed an atypical unilateral lobular lucency distorting the mediastinum. CT scan showed an air collection with a multilobular upper border, containing thin straight and curvilinear septa. All segmental bronchi were identifiable. Limited scanning in decubitus position confirmed displacement of thymus and mediastinal air. Following conservative treatment, radiographic findings and symptoms resolved. Pneumomediastinum in neonates, unlike adults, loculates and does not dissect around broncho-vascular structures. Internal septa represent fascia surrounding the thymus. Thymic elevation and absence of lung abnormality constitute helpful imaging findings in support of spontaneous pneumomediastinum so that unnecessary and potentially harmful thoracotomy or chest tube placement are confidently avoided.

• diabetic ketoacidosis
• diagnosis
• pneumomediastinum
• treatment

The thoracic inlet is located at the crossroads between imaging of the neck and chest. It represents an important anatomic landmark, serving as the central conducting pathway for many vital structures extending from the neck into the chest and vice versa. Many important body systems are located within this region, including the enteric, respiratory, vascular, lymphatic, neurologic, and endocrine systems. A detailed examination of this region is essential when reviewing neck and thoracic imaging. This article will discuss the normal anatomic boundaries of the thoracic inlet and present an image-rich systematic discussion of the non-neoplastic pathology that can occur in this region. The neoplastic pathology of the thoracic inlet will be covered in a companion article.

• Head and neck imaging
• Radiology
• Thoracic imaging
• Thoracic inlet

A 29-year-old male presented at the Emergency Department (ED) with chest pain and neck tenderness after intranasal cocaine usage. Physical exam of the patient demonstrated moderate subcutaneous emphysema on the right side of his neck. The ECG did not demonstrate any changes associated with cocaine-induced cardiac ischemia, and blood analysis was normal (negative troponins). A chest X-ray revealed subtle evidence of pneumomediastinum. Subsequent thoracic CT confirmed the presence of subcutaneous emphysema with a pneumopericardium and a large pneumomediastinum along with a small pneumothorax. The patient was managed conservatively and kept overnight for observation. He was discharged from the ED the following day with ambulatory follow-up. A repeat thoracic CT performed two weeks later demonstrated that the findings identified in the first CT had resolved. Pneumopericardium, -mediastinum, and -thorax are rare conditions reported after cocaine abuse. A conservative approach with a period of observation in a suitable ambulatory unit is acceptable, as current literature suggests that the condition is usually self-limiting.

H1N1 is seen in tropical countries like India, occurring irrespective of the season. Complications of the disease are frequently encountered and there is little in the way or guidelines as to the how these should be managed. The treatment of one such complication, a recurrent pneumiomediastinum is the subject of the current paper. The management followed guidance for the treatment of a similar condition known as primary spontaneous pneumomediastinum, an uncommon condition resulting from alveolar rupture-otherwise known as the Macklin phenomenon.

• Macklin phenomenon
• pandemic H1N1 virus
• pneumomediastinum

Imaging in intensive care unit (ICU) is integral to patient management. The portable chest radiograph is the most commonly requested imaging examination in ICU, and, despite its limitations, it significantly contributes to the decision-making process. Multidetector CT (MDCT) is reserved for relatively complex and challenging clinical scenarios. Bedside ultrasound is emerging as a promising imaging modality as it does not subject the patients to risks and resources involved in the transportation of these patients to the CT facility. Ultrasound is an effective modality to triage patients and is being increasingly incorporated into the emergency and intensive care management algorithms.

• complication
• lateral lumbar interbody fusion
• pneumomediastinum
• pneumopericardium
• retroperitoneal transpsoas approach

• Aged
• Female
• Humans
• Lumbar Vertebrae/surgery
• Mediastinal Emphysema/etiology
• Pneumopericardium/etiology
• Postoperative Complications/etiology
• Psoas Muscles/surgery
• Retroperitoneal Space/surgery
• Spinal Fusion/adverse effects
• Spinal Fusion/methods

Le pneumomédiastin spontané se définit par la présence d'air au niveau du médiastin en l'absence de cause traumatique ou iatrogène. Son diagnostic repose sur la radiographie thoracique. Le recours à d'autres examens paracliniques, tels que la tomodensitométrie thoracique ou la fibroscopie bronchique ou digestive, s'impose parfois. L'évolution est le plus souvent favorable. Nous rapportons 18 cas de pneumomédiastin spontané, colligés au service des maladies respiratoires du CHU Ibn Rochd de Casablanca entre 2006 et 2017. Il s'agit de 13 hommes et de cinq femmes dont la moyenne d'âge était de 24 ans. La symptomatologie clinique était dominée par la douleur thoracique rétrosternale. Les circonstances de survenue du pneumomédiastin étaient des quintes de toux dans sept cas, une crise d'asthme dans cinq cas, une consommation de narguilé et des vomissements Itératifs dans deux cas chacun, un accouchement et une exacerbation d'origine bactérienne de BPCO dans un cas chacun. L'évolution était favorable dans tous les cas avec une résorption spontanée du pneumomédiastin. Aucune récidive n'est survenue après un recul moyen de 3 ans.

• Pneumomediastinum
• chest pain
• emphysema
• mediastinal disease
• spontaneous

• Blunt
• Chest trauma
• Outcome
• Pneumomediastinum
• Pneumopericardium
• Severe

• Americas
• diagnosis
• disease
• disease control
• location
• other
• physiology
• respiratory tract

•

Vaginal cuff dehiscence is a rare post-operative complication after hysterectomy.

Vaginal cuff dehiscence (VCD) is a rare post-operative complication after hysterectomy in which the approximated edges of the vaginal cuff separate. Associated presentations range from simple separation with minimal bothersome symptoms to pain, infection, and surgical emergencies such as bowel evisceration. In this report we describe a rare and delayed presentation of VCD.

A 34-year-old woman underwent laparoscopy-assisted vaginal hysterectomy (LAVH) for persistent cervical dysplasia. Four months after surgery, she presented to the emergency department with diffuse vaginal bleeding and chest and abdominal pain. Prior to symptom onset she had attempted sexual intercourse for the first time since her surgery.

On pelvic exam, she had a one centimeter VCD. Chest, abdomen, and pelvis computerized tomography (CT) imaging showed pneumoperitoneum and pneumomediastinum. She was taken to the operating room for diagnostic laparoscopy, sigmoidoscopy, and endoscopy, which were unremarkable, as well as VCD repair.

We discuss how the patient’s pneumomediastinum arose secondary to air introduced into the vagina during intercourse, which then traversed the following anatomic route: abdominal cavity, diaphragmatic hiatus, retroperitoneum, and mediastinum.

We report an unusual and delayed presentation of VCD after LAVH resulting in pneumoperitoneum and pneumomediastinum. The patient was managed surgically with exploration and VCD repair and had complete resolution of symptoms. Surgeons should understand that the risk of VCD exists as long as 8–12 weeks after surgery and VCD’s varying presentations due to anatomic connection between abdominal cavity and mediastinum.

• Case report
• Hysterectomy
• Laparoscopy
• Pneumomediastinum
• Post-coital
• Vaginal cuff dehiscence