CXR Case 121

There is air visible between the inferior border of the heart and the diaphragm, and surgical emphysema in the neck.

No pneumothorax visible, normal pleura.

Lung parenchyma looks normal. No evidence of trauma.

Pneumomediastinum is associated with anything that will transiently raise the intra-thoracic pressure high enough to rupture a hole in the visceral pleura, in this case into the mediastinum.

This may include pre-existing lung / parenchymal disease or, as in this case, indiscretion with beer.

Observation only is required in the majority of cases.

In 1724, Herman Boerhaave (1668–1738) described a rupture of the oesophagus with gastric contents ejected into the pleural space, frequently associated with vomiting and resultant pneumomediastinum (Boerhaave syndrome).

There is no evidence of this in this case, but it is a condition not to be missed with a high mortality if unrecognized.