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Chest clinic
Images in thorax
Man in the bubble
Free
  1. Yu-Huei Li1,
  2. Chung-Kan Peng2
  1. 1Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  2. 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  1. Correspondence to Dr Chung-Kan Peng, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec.2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan; kanpeng{at}mail.ndmctsgh.edu.tw

https://doi.org/10.1136/thoraxjnl-2015-207463

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    A 46-year-old man, with history of asthma without regular medication, presented with persistent dyspnoea and wheezes. He received endotracheal intubation with conventional ventilator support for acute respiratory failure with severe acidosis. Acute desaturation developed on the next day. The following thoracic and abdominal CT disclosed severe subcutaneous emphysema (figure 1, short arrow), pneumomediastinum (figure 1, long arrow), pneumoperitoneum (figure 2, asterisk) and even pneumoscrotum (figure 3, arrowhead). After aggressive treatment with systemic steroids, the endotracheal tube was extubated 3 days later in a highly improved condition. The patient was discharged uneventfully, and had regular outpatient visits.

    Figure 1
    Figure 1

    Coronal chest CT showing pneumomediastinum (long arrow) and subcutaneous emphysema (short arrow).

    Figure 2
    Figure 2

    Axial abdominal CT showing pneumoperitoneum (asterisk).

    Figure 3
    Figure 3

    Coronal abdominal CT showing pneumoscrotum (arrowhead).

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    Footnotes

    • Contributors Y-HL and C-KP managed the patient. Y-HL prepared the manuscript and images. C-KP revised this article.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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