{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:17:11Z","timestamp":1792289831520,"version":"4.4.0"},"reference-count":5,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,4,6]]},"abstract":"<jats:p>A 77-year-old man was admitted with a relapse of antineutrophil cytoplasmic antibody-positive vasculitis with pulmonary involvement and acute kidney injury. There was a background of pulmonary fibrosis (non-specific interstitial pneumonia type pattern) and superadded pulmonary haemorrhage, acute pulmonary oedema and sepsis. The patient was intubated for 4\u2009days and remained dependent on high flow oxygen and continuous positive airway pressure after extubation. A chest radiograph performed 2\u2009weeks after extubation demonstrated unexpected, extensive pneumomediastinum and subcutaneous emphysema. This was confirmed on CT which raised the possibility of a tracheal defect at the level of the prior endotracheal tube cuff position. Tracheal injury was considered clinically unlikely due to the considerable interval since extubation and a short, uneventful intubation period. The cardiothoracic team recommended a diagnostic bronchoscopy but this was felt too high risk by the clinical team. The cause of pneumomediastinum and subcutaneous emphysema remained indeterminate.<\/jats:p>","DOI":"10.1136\/bcr-2018-224528","type":"journal-article","created":{"date-parts":[[2018,4,19]],"date-time":"2018-04-19T13:25:36Z","timestamp":1524144336000},"page":"bcr-2018-224528","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Unexpected case of pneumomediastinum and subcutaneous emphysema: primary or secondary aetiology?"],"prefix":"10.1136","volume":"2018","author":[{"given":"Amanda J L","family":"Cheng","sequence":"first","affiliation":[{"name":"Radiology, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J","family":"Sadler","sequence":"additional","affiliation":[{"name":"Radiology, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,4,19]]},"reference":[{"key":"2025082805133040000_2018.apr19_1.bcr-2018-224528.1","first-page":"63","article-title":"Hamman\u2019s syndrome (spontaneous pneumomediastinum presenting as subcutaneous emphysema): A rare case of the emergency department and review of the literature","volume":"23","author":"Grapatsas","year":"2018","journal-title":"Respir Med Case Rep"},{"key":"2025082805133040000_2018.apr19_1.bcr-2018-224528.2","first-page":"97","article-title":"Non-traumatic, spontaneous subcutaneous emphysema: diagnostic and therapeutic dilemma","volume":"4","author":"Venugopal","year":"2015","journal-title":"Int J Health Allied Sci"},{"key":"2025082805133040000_2018.apr19_1.bcr-2018-224528.3","first-page":"1022","article-title":"Comparison of spontaneous and secondary pneumomediastinum","volume":"2","author":"Kawata","year":"2017","journal-title":"J Resp Med and Lung Dis"},{"key":"2025082805133040000_2018.apr19_1.bcr-2018-224528.4","doi-asserted-by":"publisher","DOI":"10.4329\/wjr.v6.i11.850"},{"key":"2025082805133040000_2018.apr19_1.bcr-2018-224528.5","doi-asserted-by":"crossref","first-page":"220","DOI":"10.4097\/kjae.2010.59.3.220","article-title":"Delayed detection of subcutaneous emphysema following routine endotracheal intubation -A case report-","volume":"59","author":"Jo","year":"2010","journal-title":"Korean J Anesthesiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-224528","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:13:38Z","timestamp":1756383218000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-224528"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,19]]},"references-count":5,"alternative-id":["10.1136\/bcr-2018-224528"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-224528","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,19]]}}}