2. CASE HISTORY
•A 10 year old patient had history of injury by bicycle steering over right
side of neck and presented with chief complain of acute Shortness of
breath, Severe orthopnea (drop of 20% spo2 was noted on lying down) &
chest pain.
•on examination patient had swelling over neck and face region.

3. SEQUENTIAL X RAY FINDINGS IN PAST MONTH

4. X-RAY FINDINGS
•X-RAY CHEST & NECK SHOWS AIR AT BILATERAL NECK , OVERLYING CHEST
ANTERIORLY ( SURGICAL EMPHYSEMA ) , MEDISTINUM ( PNUMO-
MEDISTINUM ) , PLEURAL SPACE ALONG CHEST WALL ( PNUMO- THORAX ) &
PERICARDIAL SPACE (PNUMO-PERICARDIUM ).

5. CT SCAN IMAGES

7. CT FINDINGS
• EXTENSIVE SUBCUTANEOUS EMPHYSEMA IS NOTED INVOLVING BOTH SIDES OF PAROTID REGION, CHEECK,
SUBMANDIBULAR REGION, ANTERIOR PART AND LATERAL SIDE OF NECK ANDSUPERIOR ANTERIOR CHEST WALL.
• SLIT LIKE TRACK OF AIR EXTENDING FROM THE LEFT POSTERIOR PARAMEDIAN WALL OF TRACHEA (5 O’CLOCK
POSITION) TOWARDS THE SOFT TISSUE AIR FOCI AT C7 LEVEL FOR THE LENGTH OF 10 MM.
• ---POSSIBLE SITE INJURY.
LARGE AREA OF AIR IS NOTED ALONG BOTH SIDES OF TRACHEA, PULMONARY VESSELS AND BRONCHI, SUGGEST
PNEUMOMEDIASTINUM.
• MODERATE AMOUNT OF AIR IS NOTED AROUND HEART, SUGGESTPNEUMO-PERICARDIUM.
• SMALL AMOUNT OF AIR IS NOTED AT DEPENDANT PART OF BOTH LUNG FIELDS WITH SUB-SEGMENTAL ATELECTASIS,
POSSIBILITY OF PNEUMO THORAX.

8. MANAGEMENT
•TREATED CONSERVATIVE WITH ENDOTRACHEAL INTUBATION
WITH TRACHEOSTOMY.

9. SUBSEQUENT X RAY FINDING
X ray shows resolved
pneumopericardium,
pneumomediastinum
and pneumothorax.