CTICasesExtrapleural Air Mimicking Pneumothorax
Imaging findings
Serial chest radiographs of a patient with severe COVID-19 demonstrate the onset of a pneumomediastinum. Accompanying this is a small, stable collection of air in the apical regions of the hemithoraces, which is confined to the extrapleural space and does not shift or track along the lateral chest walls.
Key takeaways
Apical air collections associated with pneumomediastinum are frequently extrapleural rather than intrapleural. Unlike true pneumothorax, extrapleural air is trapped in the extrapleural space and does not slide or shift to the least dependent position when the patient's position is changed, allowing it to be recognized as a benign mimic and managed conservatively without chest tube placement.
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