PNEUMOMEDIASTINUM

A CXR showing Pneumomediastinum: note the air around the heart.

This patient had severe episodes of vomiting that have been complicated with hematemesis after binging a lot of alcohol cans (Mallory-Weiss Syndrome). As a result of these vigorous vomiting episodes, the esophagus ruptured (Boerhaave Syndrome). The most usual CXR finding of this case is left-sided pleural effusion however, pneumomediastinum may happen due to air tracking in the mediastinum (as in this case). Other cause of pneumomediastinum are trauma, pneumothorax, rupture of bronchi. It may be associated with subcutaneous emphysema in which air trackles in the subcutaneous tissue and is usually conservatively treated unless due to perforated airway in which fiberoptic bronchoscope is indicated.

DON'T forget: Stabilizing the patient and ABC are the most important initial lines of management. Treatment of rupture esophagus is basically surgical.