Pneumomediastinum: elucidation of the anatomic pathway by liquid ventilation

Partial liquid ventilation is a new technique to improve oxygenation in patients with severe acute respiratory distress syndrome. In a patient with status asthmaticus and tension pneumothorax treated with subsequent liquid ventilation, radiopaque perfluorocarbon was identified along brochiovascular structures, in the mediastinum, and in the retroperitoneum. Perfluorocarbon outlined on CT and chest radiography the anatomic pathway by which spontaneous pneumomediastinum develops following alveolar rupture, as described earlier by histopathologic study in animals. This represents the radiopaque equivalent of radiolucent pneumomediastinum. Perfluorocarbon remained in the pulmonary interstitium on radiography 30 days after beginning liquid ventilation, without sequelae.