pneumomediastinum from ingested fish bone

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anatomical compartments and their connections as demonstrated by ectopic air. Local sources of pneumomediastinum. a, b Spontaneous pneumomediastinum due to prolonged and forceful Valsalva manoeuvres in 21-year-old man. Axial CT scan with “lung window” demonstrates the Macklin effect: air is seen along the perivascular and peribronchial fascial sheaths (a), continuous to the mediastinum (red star) (b). c Oesophageal perforation by fishbone complicated by mediastinitis in a 61-year-old woman. Axial CT scan after oral iodinated contrast ingestion, distending the oesophagus (red square); extraluminal air bubbles (red arrows) are seen in mediastinum together with increased mediastinal fat attenuation, as well as multiple reactive lymph nodes. Normal permeable airways are seen (blue triangle) at level of carina