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Chest radiograph on admission demonstrating subcutaneous emphysema (red arrow) and pneumomediastinum (blue arrow).
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A chest radiograph (Figure 1) demonstrated pneumomediastinum and subcutaneous emphysema.
(a and b) Axial post contrast (CT) scan, soft tissue and lung settings, respectively, demonstrating subcutaneous emphysema (red arrow), pneumomediastinum (blue arrow) and epidural emphysema (green arrow).
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For improved delineation of the extent of the spontaneous pneumomediastinum (SPM), an urgent CT scan of the chest (Figure 2a and 2b) was performed.
(a and b) Sagittal reconstructed image through the thoracic spine and axial image at level of carina, lung settings, demonstrating epidural emphysema (green arrow).
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Air tracking into the posterior epidural space (pneumorrhachis) at multiple levels of the cervical and thoracic spinal canal was also observed (Figure 3a and b).
(a, b and c) Contrast swallow of the cervical and thoracic oesophagus excluded oesophageal perforation.
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A water-soluble contrast swallow excluded any oesophageal perforation (Figure 4).