Pneumomediastinum and pneumopericardium due to malignant subcarinal lymphadenopathy: CT demonstration

A 52-year-old man had been treated for oral cancer T3 N0 M0 by radical surgery, neck dissection on the right and cervical irradiation (60 Gy). Two months after therapy he presented with dysphagia and hemoptysis. Admission chest X-ray revealed a pneumopericardium. It was caused by a bronchomediastinal fistula due to necrotic metastatic lymph nodes as shown by CT, which also revealed a concomitant pneumomediastinum. The patient died 10 days later from pneumonia. The CT findings were confirmed at autopsy. We conclude that malignant mediastinal lymphadenopathy is a potential cause of pneumopericardium and pneumomediastinum.