Continuous Diaphragm Sign and Pneumomediastinum on Chest XRay
16yo boy referred in by his GP with7/10 chest pain. He noticed the pain when he woke up which radiated up his neck, pleuritic in nature. No dyspnoea, fevers or recent travel. He did state he was punched in the chest a week ago, playfighting with friends.
Vitally he was tachy at 106. But he was in a lot of discomfort.
On examination he did have a degree of pectus excavatum but unsure of its significance. One sign we would like to have seen but didn't was some surgical emphysema.
WCC 13 neuts 9
Managed with a short stay admission overnight with oxygen and reassessed in the morning with a repeat CXR. We saw near complete resolution.
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