MEDIASTINAL INJURY IN EMERGENCY X-RAY

•Mechanism: rapid deceleration.
•Trachea: blunt or penetrating. Usually just above or after carina. Typically fail phonation with stridor.
•Esophagus: Fail NGT insertation. Pneumomediastinum / pneumothorax (left)
•Mediastinal hemorrhage: most unrecognised clinically or radiologically.
Indirect sign: mediastinal widening.
•Aortic rupture: at the isthmus. Superior mediastinal widening.

PNEUMOMEDIASTINUM AND PNEUMOPERICARDIUM

•Result from:
Pulmonary interstitial emphysema.
Perforation esophagus, trachea or bronchus.
From pneumothorax.
From pneumoperitoneum.

PNEUMOMEDIASTINUM

•Vertical , translucent streaks, extend up to the neck.
•Air collected beneath the diaphragm – continuous diaphragm sign.

MEDIASTINAL INJURY

•Pneumomediastinum.
•Lung contusion.
•Fail NGT insertion- suspicious of esophageal injury.

•Mediastinal emphysema and deviation of ETT.
•Malalignment of ETT and trachea.
•DDx: tracheal injury