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Case Reports
. 2017 Feb;18(1):52-56.
doi: 10.1177/1751143716662665. Epub 2016 Aug 3.

Tension pneumomediastinum: A literal form of chest tightness

David J Clancy  1 , Andrew S Lane  2 , Peter W Flynn  3 , Ian M Seppelt  1
Affiliations
Case Reports

Tension pneumomediastinum: A literal form of chest tightness

David J Clancy et al. J Intensive Care Soc. 2017 Feb.

Abstract

Tension pneumomediastinum is a rare and life-threatening complication of mediastinal emphysema which can occur with mechanical ventilation. We present a case of tension mediastinum associated with mechanical ventilation in a patient with Acute Respiratory Distress Syndrome due to Pneumocystis jirovecii pneumonia. We discuss the mechanism and pathophysiology of tension pneumomediastinum, the potential association with Pneumocystis jirovecii pneumonia and recruitment manouvres, and its definitive emergency treatment.

Keywords: Pneumocystic jirovecii pneumonia; Pneumomediastinum; pneumatocele; recruitment manoeuvres.

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Figures

Figure 1.
Figure 1.
Initial CXR showing bilateral patchy shadowing associated with peribronchial thickening.
Figure 2.
Figure 2.
Extensive pneumomediastinum and subcutaneous emphysema. There is a deep sulcus sign on right side consistent with a pneumothorax.
Figure 3.
Figure 3.
Coronal section on CT—large pneumomediastinum, with significantly consolidated tissue bilaterally.
Figure 4.
Figure 4.
Transverse CT section—pneumomediastinum causing cardiac compression and compression of large vessels.
Figure 5.
Figure 5.
Transverse CT section showing air through peritoneal space. There are also hepatic cysts in a patient with background of polycystic kidney disease.
Figure 6.
Figure 6.
CXR post mediastinal drain insertion with improvement of hypotension and resolution of the pneumomediastinum.
See this image and copyright information in PMC

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