Image Diagnosis: Pneumomediastinum

Charlene Kiang, MD, is a Senior Emergency Medicine Resident in the Stanford/Kaiser Emergency Medicine Residency Program in Stanford, CA. E-mail: ckiang@stanford.edu. Gus M Garmel, MD, FACEP, FAAEM, is a Senior Emergency Medicine Physician at the Kaiser Santa Clara Medical Center, Co-Program Director of the Stanford/Kaiser Emergency Medicine Residency Program, and Clinical Professor (Affiliated) of Surgery (Emergency Medicine) at Stanford University School of Medicine in CA. He is also a Senior Editor for The Permanente Journal. E-mail: gus.garmel@kp.org. Figure 1. Anterior-posterior chest radiograph An adolescent girl, age 14 years, presents to the Emergency Department after one week of cough with chest pain, neck pain, and shortness of breath. Chest radiograph shows pneumomediastinum. Air is seen outlining the mediastinal structures and the pericardium. Pneumomediastinum can occur because of the increased pressures seen with sneezing, coughing, vomiting, and the valsalva maneuver.