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IMAGE OF THE WEEK Prof .Dr. P. Vijayaragavan’s Unit. Dr. A. Karthick Ramalingam.

Imaging: Pneumomediastinum/pneumothorax/bullae

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Page 1: Imaging: Pneumomediastinum/pneumothorax/bullae

IMAGE OF THE WEEK

Prof .Dr. P. Vijayaragavan’s Unit.

Dr. A. Karthick Ramalingam.

Page 2: Imaging: Pneumomediastinum/pneumothorax/bullae

CLINICAL SUMMARY 58 year old Mrs.Samundeswari was admitted with C/o sudden onset breathlessness and facial

swelling. H/o cough with expectoration present Initially drug allergy was suspected O/E the facial swelling was found to be due

to subcutaneous emphysema.

Page 3: Imaging: Pneumomediastinum/pneumothorax/bullae

CXR PA VIEW

Page 4: Imaging: Pneumomediastinum/pneumothorax/bullae

FINDINGS

Bony cage is normal. Soft tissue: Subcutaneous emphysema. Trachea in midline. Slight mediastinal shift towards left. Emphysematous change seen in right lung field .

8 ribs can be counted posteriorly. Flat diaphragm and air can be seen below heart Left upper zone shows a ellipsoidal translusent

area devoid of lung markings surrounded by thin wall .A septa is seen within that area.

Fibrotic changes are present in left mid and lower zone and right lower zone.

Pneumomediastinum present.

Page 5: Imaging: Pneumomediastinum/pneumothorax/bullae

Bullae with a septa within it

Pneumomediastinum

Air under heart

Page 6: Imaging: Pneumomediastinum/pneumothorax/bullae

CT CHEST

PNEUMOMEDIASTINUM

PNEUMOTHORAX

EMPHYSEMATOUS BULLAE

BRONCHIECTASIS

Page 7: Imaging: Pneumomediastinum/pneumothorax/bullae

CXR FINDINGS IN PNEUMOMEDIASTINUM

Mediastinal emphysema appears as a thin line of radiolucency that outlines the cardiac silhoutte, as well as thin lucent vertically oriented streaks of air within the mediastinum

Aorta and other posterior mediastinal structures may be highlighted, and well defined lucency around the right pulmonary artery may be seen (ring around the artery sign)

Unlike in pneumothorax or pneumoperitoneum, the air remains fixed and does not rise to the highest point

An unbroken line may extend from one hemidiaphragm to other beneath the heart – the continuous diaphragm sign

Page 8: Imaging: Pneumomediastinum/pneumothorax/bullae

CXR FINDINGS

Inner margin that is concave than convex

They should not conform to the costophrenic angle when they are at lung base

A bullae is limited to one lobe

Thin curvilinear line that is convex

Costophrenic angle will be free of vascular markings

Not limited to one lobe In a small pneumothorax

costophrenic angle blunting due to small amount of pleural fluid that collects

Deep sulcus sign positive

BULLAE PNEUMOTHORAX

Page 9: Imaging: Pneumomediastinum/pneumothorax/bullae

BULLAE

Inner margin that is concave

Page 10: Imaging: Pneumomediastinum/pneumothorax/bullae

PNEUMOTHORAX

DEEP SULCUS

Curvilear convex line

Absent lung markings

Page 11: Imaging: Pneumomediastinum/pneumothorax/bullae

Thank you