Education  |   October 2018
Delayed Tension Pneumomediastinum after Cardiac Surgery
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California.
  • Address correspondence to Dr. Wolfe: michaelwolfe@mednet.ucla.edu
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia / Respiratory System / Thoracic Anesthesia
Education   |   October 2018
Delayed Tension Pneumomediastinum after Cardiac Surgery
Anesthesiology 10 2018, Vol.129, 809. doi:10.1097/ALN.0000000000002257
Anesthesiology 10 2018, Vol.129, 809. doi:10.1097/ALN.0000000000002257
A 61-YR-OLD man underwent redo aortic and mitral valve replacement for valvular insufficiency. Routine chest radiography on postoperative day 10 revealed new mediastinal air, which progressed to tension pneumomediastinum, as seen on chest radiography (image A, black arrow) and computed tomography (image B, black arrow). Perioperative ventilatory requirements were unremarkable, with his only risk factor being recent chest surgery.
As pneumomediastinum can occur in trauma, during mechanical ventilation, or following chest or laparoscopic surgery, perioperative clinicians should be attuned to the diagnosis and management.1  Patients may report dyspnea, dysphagia, cough, or chest pain. Clinical signs may not be specific; signs include subcutaneous emphysema, electrocardiographic changes (tachycardia, premature contractions, inverted T-waves, and low voltage readings), or Hamman’s sign—a phasic crunching heard synchronous with the cardiac cycle as the heart beats against air-containing tissue.1,2  Some of these findings are also seen in pneumothorax, pericarditis, or hemopericardium, making diagnosis difficult, but diagnostic resolution is possible with chest radiography or computed tomography.