The Value of Different Radiological Modalities in Assessment of Spontaneous Pneumomediastinum: Case Review and Diagnostic Perspective

Abstract

Pneumomediastinum (PM), or a mediastinal air leak, is a known morbidity in neonates. Among predisposing factors, the most significant are mixed lung diseases, such as pneumonia or meconium aspiration syndrome, with coexisting atelectasis and airway obstruction. We report an unusual presentation of significant spontaneous pneumomediastinum in a term newborn delivered by elective cesarean section with no history of active resuscitation at birth.Timely diagnosis of SPM is important for both management and prognosis. We believe that lung ultrasound (LUS) is a promising screening tool for early detection of PM in neonates, and could help avoid unnecessary exposure to radiation in delicate neonates. More simultaneous studies comparing chest X-ray (CXR), LUS, and computed tomography (CT) scans may help to prove the utility value of point-of-care ultrasounds as a primary diagnostic tool in identifying this morbidity.

A rare cause of respiratory distress in a newborn: Pneumomediastinum

“…The diagnosis can be difficult in some cases. Chest X-ray can be negative in up to 30% of cases [11]. For the exclusion of mediastinal masses, a CT scan can be used [7].…”

Ultrasound as a problem solver to diagnose pneumomediastinum in an infant

“…3 Traditionally, chest computerized tomography (CT) has been considered the most precise radiological imaging modality to utilize in equivocal cases of pneumomediastinum on CXR because CT can accurately confirm the diagnosis even with the presence of a minimal amount of air. 4 However, potentially harmful radiation, the need for sedation, availability and the relatively high cost are known disadvantages of CT in infants.…”

“…Spontaneous pneumomediastinum is a relatively rare condition in infants and it is mostly associated with an underlying lung disease. 4 The diagnosis of pneumomediastinum is usually made based on CXR. The typical radiographic appearance is the classic 'spinnaker sail' sign, also known as the 'angel wing' sign, caused by the elevation of one or both thymic lobes superiorly and laterally by air located within the mediastinum.…”

“…2,3 It is a relatively rare condition in infants, mostly associated with an underlying lung disease. 4 Its incidence ranges from one in 800 to one in 42,000 patients presenting at hospital emergency units. 1…”

“…2,3 It is a relatively rare condition in infants, mostly associated with an underlying lung disease. 4 Its incidence ranges from one in 800 to one in 42,000 patients presenting at hospital emergency units. 1 We present a case of an infant with acute respiratory failure in whom spontaneous pneumomediastinum was initially missed by chest radiography (CXR) and later diagnosed correctly by ultrasound (US).…”