Asian Cardiovasc Thorac Ann 2008;16:434-435
© 2008 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Spontaneous Pneumomediastinum Involving Carotid Artery Neurovascular Pedicle
Efstratios Koletsis, PhD,
Christine Kalogeropoulou, PhD1,
Kostas Katsanos, MD1,
Efstratios Apostolakis, PhD,
Dimitrios Dougenis, PhD
Department of Cardiothoracic Surgery
1 Department of Radiology, Faculty of Medicine, University of Patras, Patras, Greece
For reprint information contact: Efstratios Koletsis, PhD, Tel: 30 210 895 5570, Fax: 30 2610 994 535, Email: ekoletsis{at}hotmail.com, 31 Chlois Str, 166 73 Voula, Athens, Greece.
A 23-year-old man presented with a sudden onset of sharp central thoracic pain at rest, reflecting up to the jaw. His medical history, physical examination, and routine blood tests were unremarkable, with no record of trauma. Chest radiography showed pneumomediastinum and subcutaneous emphysema (Figure 1
).
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Figure 1. Chest radiograph showing clear lungs with pneumomediastinum (white arrows) and subcutaneous emphysema (dashed arrows).
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Computed tomography revealed subcutaneous emphysema of the neck, involving the neurovascular pedicle of the carotid artery, and pneumomediastinum without pneumothorax (Figure 2). The diagnosis was spontaneous pneumomediastinum, which is usually a benign condition that responds to conservative treatment. The patient received analgesics and oxygen therapy, and was discharged from the hospital after 2 days. He continues to do well. Pneumomediastinum should be considered in the differential diagnosis of chest pain, especially in healthy young adults.
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Figure 2. (A) Multislice computed tomography showing extensive subcutaneous emphysema of the chest and the neck, surrounding the neurovascular pedicle of the carotid artery (notched white arrow). Arrows denote pneumomediastinum surrounding the bronchial tree. There is no evidence of pneumothorax or rib fracture. (B) Three-dimensional reconstruction of the air distribution, in anteroposterior view. The shape of the air collections are reminiscent of sea corals, and they are oriented parallel to the trachea (white arrows), involving the perivascular fascia.
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