Image challenge: acute chest pain after tooth extraction

Pneumomediastinum after Third Molar Extraction: Case Report, Physiopathology, and Literature Review

“…The diagnosis is suspected from clinical history and clinical findings like swelling and subcutaneous crepitations, and it can be confirmed by chest radiology, which allows visualization of the air accumulation as radiolucent areas. However, one-third of the pneumomediastinum can be missed using this imaging method [ 23 ]. Therefore, a CT scan with contrast injection should be performed to determine the extent of emphysema and infectious complications [ 2 , 9 , 21 ].…”

“…Diagnosis of subcutaneous emphysema is important because, if unnoticed, it can lead to various complications, such as pressure on the orbit, which can cause blindness [9,13], compression of the upper airway that sometimes requires intubation of the patient [1,3,14], and nerve compression (such as that of the recurrent laryngeal nerve) that causes vocal cord paresis [1]. Furthermore, subcutaneous emphysema may extend to the thorax, causing pneumopericardium [19,20] or pneumomediastinum [1, 3, 8, 10-12, [14][15][16][17][19][20][21][22][23][24][25][26][27][28]. Pressurized air can rupture the mediastinal pleura and cause pneumothorax [11,19,26].…”