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Updated: Jan 30, 2026

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Sail sign in neonatal pneumomediastinum: a case report
Stephen Sze Shing Teo1,2, Archana Priyadarshi3, Kathryn Browning Carmo4,5,6
1Paediatrics & Emergency Departments, Blacktown & Mt Druitt Hospitals, Sydney, Australia. s.teo@westernsydney.edu.au.
Background:
Pneumomediastinum is an uncommon cause of neonatal respiratory distress. Clinical history and examination of the neonate may be uninformative in determining the aetiology of the respiratory distress. Chest x-ray can be diagnostic of pneumomediastinum however is often difficult to interpret.
Case Presentation:
A 36 week gestation newborn was delivered by emergency caesarean section, intubated and given intermittent positive pressure ventilation via Neopuff™ for apnoea before being extubated to CPAP. Chest radiography initially showed bilateral upper zone opacities, presenting a diagnostic dilemma; however subsequent films demonstrated a pneumomediastinum which was managed conservatively and resolved.
Conclusions:
The "sail sign" describes an uncommon radiological appearance of a pneumomediastinum in neonates and infants. With careful conservative management, a spontaneous resolution without longterm sequelae can be expected.
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