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CASE REPORT
Pneumomediastinum, ST elevation and urgent cardiac catheterisation: a crucial triad?
  1. Amit Frenkel1,
  2. Yair Binyamin2,
  3. Vladimir Zeldetz3,
  4. Leonid Koyfman1,
  5. Moti Klein1 and
  6. Evgeni Brotfain1
  1. 1 General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  2. 2 Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  3. 3 Emergency Medicine Departemt, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  1. Correspondence to Dr Amit Frenkel, frenkela{at}bgu.ac.il

Abstract

Pneumomediastinum (PNMD) entails the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema. PNMD may cause a wide variety of signs and symptoms, as well as ECG abnormality, including ST segment changes. We present a 56-year-old man admitted to our hospital after a facial trauma. After undergoing tracheostomy, he complained of chest discomfort. A chest X-ray in the posteroanterior view showed PNMD, and an ECG was suggestive of inferior-lateral wall myocardial infarction. An urgent cardiac catheterisation identified a critical obstruction at the origin of the right coronary artery. Following a balloon angioplasty, chest discomfort continued; and the ECG ST segments did not show any dynamic change during the subsequent 72 hours. We urge clinicians to perform a comprehensive workup for every patient presenting with PNMD and ST segment changes, to prevent unnecessary invasive procedures.

  • adult intensive care
  • pneumomediastinum
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Footnotes

  • Patient consent for publication Obtained.

  • Contributors AF and EB contributaed to study conception & design. YB and LK contributed to the manuscript drafting. VZ and MK contributed to critical manuscript revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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