CTICasesPneumomediastinum and Interstitial Emphysema in ARDS
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Imaging findings
Initial imaging showed acute lung injury/edema consistent with ARDS. Follow-up imaging demonstrated a large amount of pneumomediastinum with associated subcutaneous emphysema in the neck. Characteristic signs of pneumomediastinum were visible, including a 'double wall sign' related to the left main bronchus. Additionally, a 'ring around the artery' sign, indicative of interstitial emphysema, was identified around an intrapulmonary artery.
Key takeaways
Pneumomediastinum is a known complication of ARDS, often associated with diffuse alveolar damage and barotrauma from mechanical ventilation. Recognizing the imaging signs of pneumomediastinum (e.g., double wall sign, continuous diaphragm sign) and interstitial emphysema (e.g., ring around the artery sign) is crucial in these critically ill patients. Interstitial emphysema is a precursor to pneumomediastinum, as air dissects along bronchovascular sheaths.
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