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A diver with symptoms of mediastinal emphysema may also have any combination of arterial gas embolism, pneumothorax and subcutaneous or pulmonary interstitial emphysema. Factors which may prevent free escape of the compressed breathing gas include holding the breath or respiratory obstructions such as cysts, mucus plugs, or scar tissue. [10]
Associated findings such as air surrounding other mediastinal structures, such as the esophagus or great vessels may be present. Subcutaneous emphysema or air tracking into the neck may also be seen. This sign may also be diagnosed in X-ray images, although the sensitivity is much lower than that of CT. [4]
Emphysema is a respiratory disease of the lower respiratory tract. [7] It is commonly caused by tobacco smoking but some people are affected who have never smoked. [14] The presence of emphysema is a clear risk factor for lung cancer, made stronger in those who smoke. [20] Early symptoms of emphysema vary.
Signs and symptoms of spontaneous subcutaneous emphysema vary based on the cause, but it is often associated with swelling of the neck and chest pain, and may also involve sore throat, neck pain, difficulty swallowing, wheezing and difficulty breathing. [5] Chest X-rays may show air in the mediastinum, the middle of the chest cavity. [5]
On chest x-ray, one lung will be significantly more inflated than the other, causing a mediastinal shift. Bullous emphysema's radiographic appearance on x-ray mimics a tension pneumothorax. This presents a medical challenge as these diseases are treated differently despite appearing similarly on x-ray. [24] [25]
Ground-glass opacity (GGO) is a finding seen on chest x-ray (radiograph) or computed tomography (CT) imaging of the lungs. It is typically defined as an area of hazy opacification (x-ray) or increased attenuation (CT) due to air displacement by fluid, airway collapse, fibrosis , or a neoplastic process . [ 1 ]