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Mediastinal vacuum phenomenon: atypical pneumomediastinum caused by gas replacement of diminished fat

Authors Hagiwara H, Torii I

Received 3 August 2015

Accepted for publication 14 October 2015

Published 3 November 2015 Volume 2015:8 Pages 283—286


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Ronald Prineas

Hiroaki Hagiwara,1 Ikuo Torii2

1Department of Radiology, Yokohama Minamikyosai Hospital, 2Department of Radiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan

Abstract: We report a case involving an 83-year-old man with interstitial lung disease who developed atypical pneumomediastinum caused by gas replacement of diminished fat. The patient presented with a complaint of worsening symptoms of respiratory difficulty since a diagnosis of chronic eosinophilic pneumonia 5 months back. He had been under observation with no particular treatment for 5 months. Computed tomography performed on admission revealed pneumomediastinum. When the current scan was compared with that obtained 5 months ago, it was evident that the fat surrounding the mediastinum had been replaced by gas density. There was no mediastinal enlargement, pneumothorax, or pneumopericardium. Because the patient was elderly, home oxygen therapy was initiated for the interstitial pneumonia with no steroid therapy. Computed tomography performed 10 months after discharge showed the reappearance of mediastinal fat and no evidence of gas density. This case is unique because the pneumomediastinum was distinct from spontaneous pneumomediastinum caused by alveolar air leaks and resembled the vacuum phenomenon caused by intervertebral disc degeneration.

Keywords: spontaneous pneumomediastinum, vacuum phenomenon, interstitial lung disease, anorexia nervosa

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