UMEM Educational Pearls


50 yo female s/p motor vehicle crash. Diagnosis?


Answer: Pneumomediastinum from pneumothorax




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.