Pneumomediastinum, ST elevation and urgent cardiac catheterisation: a crucial triad?. Issue 2 (6th February 2019)

• Record Type: Journal Article
• Authors: Frenkel, Amit; Binyamin, Yair; Zeldetz, Vladimir; Koyfman, Leonid; Klein, Moti; Brotfain, Evgeni
• Is Part Of: BMJ case reports. Volume 12:Issue 2(2019)
• Publication Date: 2019-02-06
• Subjects: adult intensive care -- pneumomediastinum; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-227932
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Pneumomediastinum (PNMD) entails the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema. PNMD may cause a wide variety of signs and symptoms, as well as ECG abnormality, including ST segment changes. We present a 56-year-old man admitted to our hospital after a facial trauma. After undergoing tracheostomy, he complained of chest discomfort. A chest X-ray in the posteroanterior view showed PNMD, and an ECG was suggestive of inferior-lateral wall myocardial infarction. An urgent cardiac catheterisation identified a critical obstruction at the origin of the right coronary artery. Following a balloon angioplasty, chest discomfort continued; and the ECG ST segments did not show any dynamic change during the subsequent 72 hours. We urge clinicians to perform a comprehensive workup for every patient presenting with PNMD and ST segment changes, to prevent unnecessary invasive procedures.