CASE 567 Published on 06.11.2000

Teaching Case

Section

Chest imaging

Case Type

Clinical Cases

Authors

M. Wintermark, P. Schnyder

Patient

12 years, male

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Clinical History

Blunt trauma in a child

Differential Diagnosis List

Blunt traumatic pneumomediastinum outlining thymic remnants in child blunt trauma

Imaging Findings

12-year-old male child involved in a blunt trauma (traffic accident)

Discussion

Radiological patterns of blunt traumatic pneumomediastinums are similar in children and in adults. Two specifics patterns are allowed by the presence of thymic remnants in children. Anterior air collections elevating the thymic lobes on front chest X--rays create a crescent-shaped configuration mimicking a spinnaker sail (“thymic spinnaker-sail” sign), whereas perithymic air collections associated with small bilateral pneumothoraces feature a soft-tissue density simulating the rockers of an infant’s cradle (“rocker--bottom thymus“ sign).

References

[1] Kogutt MS (1981)
'Rocker-bottom thymus'. A new sign of pneumomediastinum in the neonate.
JAMA 246: 770-771. (PMID: 7253143)

[2] Moseley JE (1960)
Loculated pneumomediastinum in the newborn. A thymic "spinnaker sail" sign.
Radiology 75: 788-790.

[3] Wintermark M, Gudinchet F, Schnyder P (2000) Pediatric chest trauma. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg New York, pp 135-146.

Case information