Minimally invasive treatment of retrocardiac tension pneumomediastinum in an extremely low birth weight infant


A 23.4-week premature and extremely low birth weight neonate was transferred to the Neonatal Intensive Care Unit for management of respiratory failure and retrocardiac pneumomediastinum, suspected to be the result of a low tracheal injury during intubation. Initial conservative management failed and chest radiographs demonstrated worsening retrocardiac pneumomediastinum. Due to the patient’s extreme low birth weight and location of the pneumomediastinum, surgery was deemed to be very high risk and potentially fatal. We report the successful definitive percutaneous management of retrocardiac tension pneumomediastinum with a minimally invasive bedside method using an intercostal paraspinal approach under the guidance of ultrasound and plain radiography.

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  1. 1.

    Rosenfeld DL, Cordell CE, Jadeja N (1990) Retrocardiac pneumomediastinum: radiographic finding and clinical implications. Pediatrics 85:92–97

    CAS  PubMed  Google Scholar 

  2. 2.

    Amodio JB, Berdon WE, Abramson SJ et al (1986) Retrocardiac pneumomediastinum in association with tracheal and esophageal perforations. Pediatr Radiol 16:380–383

    CAS  Article  Google Scholar 

  3. 3.

    Kyle A, Veldtman G, Stanton M et al (2012) Barotrauma-associated posterior tension pneumomediastinum, a rare cause of cardiac tamponade in a ventilated neonate: a case report and review of the literature. Acta Paediatr Int J Paediatr 101:e142–e144

    Article  Google Scholar 

  4. 4.

    Cunningham LC, Jatana KR, Grischkan JM (2013) Conservative management of iatrogenic membranous tracheal wall injury: a discussion of 2 successful pediatric cases. JAMA Otolaryngol Head Neck Surg 139:405–410

    Article  Google Scholar 

  5. 5.

    Baird CW, Watts LT, Lessaris KJ (2009) Nonoperative management of an extensive tracheal injury in an 860-g preterm neonate. J Thorac Cardiovasc Surg 137:787–788

    Article  Google Scholar 

  6. 6.

    Bowen A 3rd, Quattromani FL (1980) Infraazygous pneumomediastinum in the newborn. AJR Am J Roentgenol 135:1017–1021

    Article  Google Scholar 

  7. 7.

    Morrison SC, Fletcher BD (1985) Infra-azygous pneumomediastinum versus pulmonary ligament air collection: CT evaluation. Pediatr Radiol 15:129–130

    CAS  Article  Google Scholar 

  8. 8.

    Beckstrom AC, Ricca RL, Gow KW, McAdams RM (2012) Persistent posterior pneumomediastinum in a neonate. Pediatr Int 54:441–442

    Article  Google Scholar 

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The authors acknowledge the Interventional Radiology Team at Children’s National Hospital.

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Correspondence to Anthony Ho.

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Ponkowski, M.J., Yadav, B., Meagher, E. et al. Minimally invasive treatment of retrocardiac tension pneumomediastinum in an extremely low birth weight infant. Pediatr Radiol (2020).

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  • Extremely low birth weight
  • Interventional radiology
  • Low tracheal injury
  • Neonate
  • Pneumomediastinum
  • Ultrasound