Pneumomediastinum

A 23 year-old woman came into the ER with severe chest pain and sob. We obtained a CTA chest to evaluate for pulmonary embolism. Instead of pulmonary embolism, the Radiologist found a pneumomediastinum on the patients left side and subcutaneous air continuing superiorly into the neck. The patient had no prior diagnosis of these conditions and had not experienced any trauma. Pneumomediastinum is not common and can be caused by several factors. These can include sudden altitude changes, trachea tear, inhalants, and trauma. Subcutaneous air or emphysema in the neck is usually a result of the pneumomediastinum. These images are examples of pneumomediastinum and subcutaneous emphysema.

Perfusion Study

My facility practices a stroke protocol for patients who exhibit signs of stroke. This test is very common and we do this on average once per day. Recently, a 70 year-old woman came in with signs of generalized weakness. While waiting to be treated the patient began to feel specific weakness on one side and trouble with speech. This patient was then immediately treated as a stroke protocol. Indications of stroke include slurred speech, droopy face, loss of vision, painful headache, weakness on one side, and loss of balance. To diagnose stroke we performed a perfusion study. This includes a CT brain w/o contrast followed by a perfusion of the brain with 40 ml of contrast injected at 7ml/sec. The 952 images obtained during the perfusion study are sent to a workstation where the blood flow is measured. This exam is then followed by a CTA head and neck where 100ml of contrast is injected at 4ml/sec. This test is usually performed on patients who have exhibited signs of stroke for less than one hour.