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      The Radiological Manifestations of the Aberrant Air Surrounding the Pleura: In the Embryological View

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          Abstract

          The radiological manifestations of the aberrant air surrounding the pleura are varied because of the air outlining the organs in and out of the visceral space. The continuity of the visceral space from the neck, mediastinum to the retroperitoneum is originated from embryological development, which is compatible with the findings through laboratory experiments, cadaveric anatomy, and thoracic computer tomography image. We reviewed the embryo development to understand the anatomy of body cavity, which can determine the radiological findings of pneumomediastinum and pneumothorax.

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          Most cited references 23

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          Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management.

          Subcutaneous emphysema and pneumomediastinum occur frequently in critically ill patients in association with blunt or penetrating trauma, soft-tissue infections, or any condition that creates a gradient between intra-alveolar and perivascular interstitial pressures. A continuum of fascial planes connects cervical soft tissues with the medlastinum and retroperitoneum, permitting aberrant air arising in any one of these areas to spread elsewhere. Diagnosis is made in the appropriate clinical setting by careful physical examination and inspection of the chest roentgenogram. While the presence of air in subcutaneous or mediastinal tissue is not dangerous in itself, prompt recognition of the underlying cause is essential. Certain trauma-related causes may require surgical intervention, but the routine use of chest tubes tracheostomy, or mediastinal drains is not recommended.
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            Pneumomediastinum revisited.

            Pneumomediastinum may result from a variety of causes that may be either intrathoracic (eg, narrowed or plugged airway, straining against a closed glottis, blunt chest trauma, alveolar rupture) or extrathoracic (eg, sinus fracture, iatrogenic manipulation in dental extraction, perforation of a hollow viscus [corrected]. The radiographic signs of pneumomediastinum depend on the depiction of normal anatomic structures that are outlined by the air as it leaves the mediastinum. These signs include the thymic sail sign, "ring around the artery" sign, tubular artery sign, double bronchial wall sign, continuous diaphragm sign, and extrapleural sign. In distal esophageal rupture, air may migrate from the mediastinum into the pulmonary ligament. Pneumomediastinum may be difficult to differentiate from medial pneumothorax and pneumopericardium. Occasionally, normal anatomic structures (eg, major fissure, anterior junction line) may simulate air within the mediastinum. Iatrogenic entities that may simulate pneumomediastinum include helium in the balloon of an intraaortic assist device. In addition, pneumomediastinum may be simulated by the Mach band effect, which manifests as a region of lucency adjacent to structures with convex borders. The absence of an opaque line, which is typically seen in pneumomediastinum, can aid in differentiation. Computed tomographic (CT) digital radiography and conventional CT can also be helpful in establishing or confirming the diagnosis.
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              Langman’s medical embryology

               TW Sadler,  J Langman (2000)
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                Author and article information

                Journal
                Pulm Med
                Pulm Med
                PM
                Pulmonary Medicine
                Hindawi Publishing Corporation
                2090-1836
                2090-1844
                2012
                10 April 2012
                : 2012
                Affiliations
                1Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Main Branch Hospital, Taipei 10449, Taiwan
                2Mackay Medicine, Nursing and Management College, Taipei 10449, Taiwan
                3Department of Thoracic Surgery, Mackay Memorial Hospital, Main Branch Hospital, Taipei 10449, Taiwan
                4Department of Diagnostic Radiology, Mackay Memorial Hospital, Main Branch Hospital, Taipei 10449, Taiwan
                5Semmelweis University, Budapest, Hungary
                6Division of Chest, Internal Medicine, Mackay Memorial Hospital, Main Branch Hospital, Taipei 10449, Taiwan
                Author notes

                Academic Editor: Takashi Nakano

                Article
                10.1155/2012/290802
                3337511
                22567276
                Copyright © 2012 Shih-Yi Lee et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Review Article

                Respiratory medicine

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