Presentation
The patient is a newborn male presenting with respiratory distress requiring CPAP after an emergent category one cesarean section for cord prolapse. He was born at 37 + 3 gestation, a birth weight of 2600g and APGAR scores of 7, 8 and 9 at the 1-, 5- and 10-minute mark respectively.
Patient Data
Small bilateral pneumothorax is present. There is also evidence of pneumomediastinum with Spinnaker sign. The lungs are otherwise clear. Heart size is normal. Nasogastric tube is appropriately positioned.
Case Discussion
Pneumomediastinum (PM) is defined as extraluminal mediastinal gas. Two variants of PM include: spontaneous PM whereby the pressure gradient between alveolus and surrounding tissue causes rupture with extension of air into the mediastinum and secondary PM caused by disruption of the aerodigestive tract.
Chest radiograph is commonly known as the tool for imaging PM. Linear lucencies separating parietal pleura from mediastinal viscera often provide the best diagnostic clue for identifying PM. These can uplift the thymus in infants – known as the Spinnaker or angel wing sign. This is seen in the chest radiograph provided. Other signs include the continuous diaphragm sign (visible superior surface of central diaphragm due to air between the diaphragm and pericardium) and the vanishing heart sign (lucency over cardiac silhouette on supine view).
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