Article

Continuous diaphragm sign.

Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California.
The western journal of emergency medicine 11/2011; 12(4):526-7. DOI: 10.5811/westjem.2011.4.2283
Source: PubMed
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    ABSTRACT: Attention is called to a radiological finding noted in some cases of pneumomediastinum. It is the interposition of air between the heart and the diaphragm on a frontal radiograph, permitting visualization of the central portion of the diaphragm in continuity with the lateral portions. The author refers to this as “the continuous diaphragm sign”. Its identification and its differentiation from pneumopericardium is discussed.
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    ABSTRACT: In pneumopericardium, a rare but potentially life threatening differential diagnosis of chest pain with a broad variety of causes, rapid diagnosis and adequate treatment are crucial. In upright posteroanterior chest radiography, the apical limit of a radiolucent rim, outlining both the left ventricle and the right atrium, lies at the level of the pulmonary artery and ascending aorta, reflecting the anatomical limits of the pericardium. The band of gas surrounding the heart may outline the normally invisible parts of the diaphragm, producing the continuous left hemidiaphragm sign in an upright lateral chest radiograph. If haemodynamic conditions are stable, the underlying condition should be treated and the patient should be monitored closely. Acute haemodynamic deterioration should prompt rapid further investigation and cardiac tamponade must be actively ruled out. Spontaneous pneumopericardium in a 20 year old man is presented, and its pathophysiology described.
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    ABSTRACT: Pneumomediastinum, also known as mediastinal emphysema, represents extraluminal gas in the mediastinum. Pneumomediastinum can lead to pneumothorax, pneumopericardium, pneumoperitoneum, or pneumoretroperitoneum. There are many causes of pneumomediastinum (Table 1) and several radiographic signs: pneumopericardium, continuous diaphragm sign, continuous left hemidiaphragm sign, Naclerio's V sign, V sign at confluence of brachiocephalic veins, ring-around-the-artery sign, thymic spinnaker-sail sign, and extrapleural air sign. We review the common and uncommon signs of pneumomediastinum and present some new signs. We also address the problem of distinguishing pneumomediastinum from pneumothorax and pneumopericardium.
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