Pneumomediastinum

Pneumomediastinum indicates the presence of gas within the mediastinum. Most of the time, mediastial emphysema penetrates to the cervical tissue as well. We call it subcutaneous and mediastinal emphysema.

thumb|150px|Pneumotorax and pneumomediastinum thumb|200px|Pneumomediastinum

The gas can enter the mediastinum either via rupture in the lung and visceral pleura, oesophagial rupture (Boerhaave's oesophagus), then if the skin is torn due to trauma or when carrying out an instrumental procedure (typical for central catethetrisation).

The gas can be produced by anaerobic bacteria directly at the spot if the structures in mediastium are infiltrated extensively. Infection can spread from lungs, oesophagus (typical for perforation - trauma, carcinoma disintegration) or descend from the neck.

Diagnosis
In physical examination, neck and upper chest is visibly enlarged, irregularly permeated with gas. When touched, cracking of small bubbles in subcutaneous tissue could be felt, that resembles the cracking of snow when squeezed. On basic X-ray imaging, small gas penetration can be missed. However, the thymic sail sign is typical – craniolateral deviation of thymic lobes. náhled|Příznak lodní plachty spinakru (vpravo) Diagnostically, CT has a higher value, in some cases we can determine the origin of the gas.

Therapy
Pneumomediastinum is not drained. The origin of the gas is secured in order to prevent enlargement and volume increase.

Complications
Most frequent and most dangerous complication is infection → inflammation (mediastinitis), which often results in fatal generalised sepsis and destruction of mediastinal organs.

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