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Unexpected case of pneumomediastinum and subcutaneous emphysema: primary or secondary aetiology?
  1. Amanda J L Cheng,
  2. Timothy J Sadler
  1. Radiology, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to Dr Amanda J L Cheng, a.cheng{at}


A 77-year-old man was admitted with a relapse of antineutrophil cytoplasmic antibody-positive vasculitis with pulmonary involvement and acute kidney injury. There was a background of pulmonary fibrosis (non-specific interstitial pneumonia type pattern) and superadded pulmonary haemorrhage, acute pulmonary oedema and sepsis. The patient was intubated for 4 days and remained dependent on high flow oxygen and continuous positive airway pressure after extubation. A chest radiograph performed 2 weeks after extubation demonstrated unexpected, extensive pneumomediastinum and subcutaneous emphysema. This was confirmed on CT which raised the possibility of a tracheal defect at the level of the prior endotracheal tube cuff position. Tracheal injury was considered clinically unlikely due to the considerable interval since extubation and a short, uneventful intubation period. The cardiothoracic team recommended a diagnostic bronchoscopy but this was felt too high risk by the clinical team. The cause of pneumomediastinum and subcutaneous emphysema remained indeterminate.

  • mechanical ventilation
  • radiology
  • interstitial lung disease
  • adult intensive care

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  • Contributors Planning, patient consent and original case report authored by AJLC. Critical review of drafts with included edits to the original report by TJS. Final edit approved by AJLC and TJS.

  • 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.

  • Patient consent Obtained.

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

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