Imaging neonatal spontaneous pneumomediastinum using ultrasound

Abstract

PurposeTo evaluate the feasibility of ultrasound in detecting spontaneous pneumomediastinum in the neonatal intensive care unit (NICU) and illustrate the ultrasound features.MethodsAmong neonates with abnormal mediastinal radiolucency suspected on chest radiography, those referred for ultrasound examination within 2 days were included. Anterior mediastinal ultrasound was performed using a linear transducer (5–12 MHz) to determine the presence and location of abnormal air in the mediastinum. Clinical data for the neonates were also reviewed.ResultsOn ultrasound, pneumomediastinum appeared as thick linear/curvilinear echogenic lines, some with posterior shadowing located between the anterior chest wall and thymus, in lateral margins of the thymus, between the thymus and the great vessels, and in the middle of the thymic parenchyma.ConclusionsUsing ultrasound, pneumomediastinum was easily visualized, and localization of the abnormal air accumulation was possible. Ultrasound may be used as a radiation-free supplementary imaging modality for neonates with abnormal mediastinal air.

Diagnostic value of lung ultrasound for neonatal respiratory distress syndrome: a meta-analysis and systematic review

“…Copetti et al [11] maintained that air-leak syndrome (pneumomediastinum, interstitial emphysema, pneumopericardium) and complications of NRDS cannot be detected using LUS. Nonetheless, June et al [50] claimed that pneumomediastinum could be easily visualized and abnormal air accumulation could be localized by ultrasound.…”

Spontaneous Pneumomediastinum on Bedside Ultrasound: Case Report and Review of the Literature

“…The study demonstrated not only the ability to detect the pneumomediastinum, but also identifies the location of air collection, which is most commonly the anterior margin of the thymus. This correlates with the raised thymus causing the spinnaker sail signs present on CXR 16…”

Sonography of the Pediatric Chest

“…In infants, mediastinal air typically accumulates beneath the thymus and elevates it from the heart, producing the “angel wing” sign. This pattern of air collection is also shown on sonography, with the air seen as echogenic lines or pockets along the posterior or lateral margins of the thymus 42 (Figure 21).…”

“…air collection is also shown on sonography, with the air seen as echogenic lines or pockets along the posterior or lateral margins of the thymus 42 (Figure 21).…”