Abstract
An 89-year-old woman with idiopathic pulmonary fibrosis (IPF) and a previous right mastectomy and implant for breast cancer presented with worsening breathlessness. There was no history of cough, haemoptysis, chest pain or fever. The chest radiograph (CXR, Fig. A) showed extensive fibrotic changes in both lungs consistent with the known diagnosis of IPF. A computerised tomo - graphy (CT) scan of the thorax revealed marked pneumo - mediastinum (black arrows) extending throughout the length the mediastinum (Fig. B). No subcutaneous emphysema was noted and no obvious cause for the pneumomediastinum was identifiable. There was no history of trauma or evidence to suggest pulmonary or mediastinal infection from gas-forming organisms. There was also no recent history of tracheobronchial or oesophageal interventions and a barium swallow excluded an oesophageal rupture. A diagnosis of spontaneous pneumomediastium (SPM) was made. The patient was managed conservatively. Her dyspnoea gradually improved and she was discharged home.