case_images: PMC10710853_01
case_images: X-ray of the lungs: There was a suspicion of bilateral pneumothorax, with a gap of about 1 cm on the right side and 7 mm on the left side at the apex. Additionally, air was seen around the heart, in the mediastinum, and up the neck. This is not a typical picture, but there may be pneumopericardium and pneumomediastinum. The radiologist suggested further tests would be needed to confirm the findings.
case_images: UJMS-128-10281-g001.jpg
case_images: PMC10710853_01_UJMS-128-10281-g001.jpg
case_images: F0001
case_images: A chest X-ray indicated the presence of bilateral pneumothorax and pneumomediastinum (Figure 1a-b).
case_images: (a-f) Chest CT: As with the previous chest X-ray, a bilateral pneumothorax was confirmed. Pronounced pneumomediastinum extending up the neck bilaterally. Air (red arrow) has also been dissected along large bronchi and to the pericardium.
case_images: UJMS-128-10281-g002.jpg
case_images: PMC10710853_01_UJMS-128-10281-g002.jpg
case_images: F0002
case_images: A subsequent computed tomography of the chest confirmed bilateral pneumothorax, pneumomediastinum with air extending up to the neck, pneumopericardium, and pneumoperitoneum (Figure 2a-f). Additionally, the air was observed dissecting along the major bronchus toward the pericardium (Figure 2f). A small amount of air was noted to have dissected its way up to the neck, right up to the base of the skull (Figure 2a-e).
case_images: Level of plasma highly sensitive troponin on arrival at the emergency department to the next day.
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case_images: PMC10710853_01_UJMS-128-10281-g003.jpg
case_images: F0003
case_images: The blood test indicated increased high-sensitive troponin levels, ranging 34 to 328 (Figure 3), while the repeated ECG was normal.