Spontaneous multiseptated cystic pneumomediastinum in a term newborn

Spontaneous pneumomediastinum in A term newborn: atypical radiographic and ct appearances

Spontaneous pneumomediastinum in the term newborn is relatively rare. We aim to emphasize the significance of Radiographic and CT features of spontaneous pneumomediastinum. We present an otherwise healthy 4-hour-old male, born by a caesarean section, presenting with sudden bulging of the left hemithorax and moderate respiratory distress. Chest radiography revealed an atypical unilateral lobular lucency distorting the mediastinum. CT scan showed an air collection with a multilobular upper border, containing thin straight and curvilinear septa. All segmental bronchi were identifiable. Limited scanning in decubitus position confirmed displacement of thymus and mediastinal air. Following conservative treatment, radiographic findings and symptoms resolved. Pneumomediastinum in neonates, unlike adults, loculates and does not dissect around broncho-vascular structures. Internal septa represent fascia surrounding the thymus. Thymic elevation and absence of lung abnormality constitute helpful imaging findings in support of spontaneous pneumomediastinum so that unnecessary and potentially harmful thoracotomy or chest tube placement are confidently avoided.

Pneumomediastinum Mimicking Congenital Pulmonary Airway Malformation

Pneumomediastinum is the collection of free air in the mediastinum. Its incidence is higher in preterm infants and those on positive airway pressure support or on mechanical ventilation. But it has decreased dramatically after the introduction of surfactant and synchronized, non-invasive mechanical ventilation. Underlying cystic lesions could also increase the risk of pneumomediastinum and other air leak syndromes. Most cases resolve spontaneously but rare hemodynamic compromise may require ultrasound-guided intervention.

Pneumomediastinum in the neonate

A pneumomediastinum is an air leak in which the free air is concentrated in the mediastinum. Although most neonatal pneumomediastinums do not require intervention, complications such as subsequent air leaks can arise. Proper radiologic identification, as well as an understanding of the anatomy and pathophysiology associated with a pneumomediastinum, are necessary for an accurate understanding and diagnosis. This article will review the interpretation of radiologic findings in a neonate with a pneumomediastinum.