35 yr female presented in ER with complains of Breathlessness on and off from past 15 days, dry cough from 15 days, chest pain from past 15 days. B/L coarse crackles on auscultation , saturation is 88% at room air, vitals stable, ECG normal. Past h/o ATT for 6 months 3 yr back for Pulmonary TB. Diagnosis ??

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Pneumomediastinum. Caused by oesophageal rupture,bowel rupture,asthma leading to alveolar rupture or blunt trauma. Also caused by sudden change in pressure like SCUBA diving. On auscultation we can hear crunching sound with the cardiac cycle called as HAMMAN'S crunch. It's diagnosed by a radiolucent line around the heart and mediasinum. Leads to shortness of breath.... Many a times resolves by its own as the surrounding tissue absorbs the air.

Yes... its Pneumomediastinum CT chest shows multiple air pockets with in the mediastinum with post TB fibrotic changes in basal zone

pneumomediastinum with old fibrotic changes in lung

Pneumomediastinum with old fibrotic changes

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Chest scan NAD.

Pneumo mediastinum.
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