PMC10081667_01
Chest computed tomography (CT) in the axial plane showing pneumomediastinum outlining the heart and other mediastinal structures. The lung parenchyma shows multiple bilateral peripheral and subpleural areas of ground-glass opacities.
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When her symptoms exacerbated, CT chest was repeated, and there was a considerable progression of the pneumomediastinum, with an extension of the air to the subcutaneous tissue causing subcutaneous emphysema (Figure 1).
Axial chest CT with contrast showing the progression of the pneumomediastinum with air pockets in the left para-mediastinal region and subcutaneous emphysema.
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In addition, the pneumomediastinum seemed to have extended to the lower neck and the left para-mediastinal region; there was extensive subcutaneous emphysema (Figures 2 and 3).  
Coronal CT of the chest with contrast showing extensive pneumomediastinum and subcutaneous emphysema.
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In addition, the pneumomediastinum seemed to have extended to the lower neck and the left para-mediastinal region; there was extensive subcutaneous emphysema (Figures 2 and 3).  
PMC10081667_02
Axial CT of the upper chest with contrast for the second patient, showing pneumomediastinum, along with bilateral subcutaneous emphysema, more predominant on the right side.
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A follow-up CT chest one month later showed pneumomediastinum along with minimal bilateral pneumothorax (Figure 4). 