CTICasesPneumomediastinum on VV ECMO
Imaging findings
Bedside chest radiographs show classic signs of pneumomediastinum: the double wall sign (air outlining both sides of the tracheal wall), partial air outlining the azygos vein, and the appearing heart sign (air in the paracardiac fat highlighting the heart border). Widespread consolidation is present in a patient on VV ECMO.
Key takeaways
Ventilator-induced barotrauma leads to alveolar rupture and dissection of air along the bronchovascular sheaths to the mediastinum (Macklin phenomenon). On radiographs, this presents as gas outlining mediastinal structures such as the trachea, azygos vein, and cardiac margins.
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