CTICasesPneumomediastinum with the "Appearing Heart" Sign
Imaging findings
In a critically ill, mechanically ventilated patient, serial chest radiographs one day apart show a portion of the left ventricle and right atrium becoming newly visible against the surrounding mediastinum, whereas previously that portion of the cardiac silhouette had been effaced by mediastinal fat. There are accompanying findings of pneumomediastinum, including a continuous diaphragm sign and air tracking through the thoracic inlet.
Key takeaways
The presenter proposed the term "appearing heart sign" to describe this newly visible cardiac contour, which results from air dissecting into the mediastinal fat that previously effaced portions of the cardiac silhouette against the mediastinum. Recognizing this sign highlights a subtle radiographic clue to pneumomediastinum that can be appreciated even without other more classic findings, based on a change in the conspicuity of the cardiac border rather than a change in heart size or position.
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