IS case 487: Pneumomediastinum with spinnaker sail sign

Narasimhachar Prativadi, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30

History

Patient is a 1-day-old premature male, intubated, with respiratory distress syndrome, given surfactant, and having increased oxygen requirements.

Discussion

Pneumomediastinum is the presence of air within the mediastinum. On the frontal chest radiograph, classic signs of pneumomediastinum include air between the heart and mediastinal pleural surfaces, air present at the base of the heart, air producing irregular radiolucent streaks in the paratracheal area, and cervical subcutaneous emphysema. Causes include asthma, barotrauma, childbirth, pneumothorax, tracheobronchial laceration, esophageal perforation, mediastinal surgery, Boerhaave's syndrome, intraperitoneal and retroperitoneal bowel perforation, retroperitoneal surgery, esophageal rupture, facial fractures, mediastinitis, dental or retropharyngeal infection. This case is a good example of the Spinnaker sail sign in which the thymus is lifted off of the mediastinum by air in the mediastinum.

References

  1. Donnelly LF. Pediatric Imaging: The Fundamentals. Philadelphia: Saunders, 2009.
  2. Harris WW. The Radiology of Emergency Medicine, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2000.
  3. Weissleder R, Wittenberg J, Harisinghani MG, et al. Primer of Diagnostic Imaging, 4th ed. Philadelphia: Mosby Elsevier, 2007.

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