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Pneumomediastinum is an uncommon cause of neonatal respiratory distress. Clinical history and examination of the neonate may be uninformative in determining the aetiology of the respiratory distress. Chest xray can be diagnostic of pneumomediastinum however is often difficult to interpret. | Teo et al. BMC Pediatrics 2019 19 38 https doi.org 10.1186 s12887-019-1397-7 CASE REPORT Open Access Sail sign in neonatal pneumomediastinum a case report Stephen Sze Shing Teo1 2 Archana Priyadarshi3 and Kathryn Browning Carmo4 5 6 Abstract Background Pneumomediastinum is an uncommon cause of neonatal respiratory distress. Clinical history and examination of the neonate may be uninformative in determining the aetiology of the respiratory distress. Chest x-ray can be diagnostic of pneumomediastinum however is often difficult to interpret. Case presentation A 36 week gestation newborn was delivered by emergency caesarean section intubated and given intermittent positive pressure ventilation via Neopuff for apnoea before being extubated to CPAP. Chest radiography initially showed bilateral upper zone opacities presenting a diagnostic dilemma however subsequent films demonstrated a pneumomediastinum which was managed conservatively and resolved. Conclusions The sail sign describes an uncommon radiological appearance of a pneumomediastinum in neonates and infants. With careful conservative management a spontaneous resolution without longterm sequelae can be expected. Keywords Neonate Pneumomediastinum Thymus Background Respiratory distress in the neonate is a frequent clinical scenario. Common causes include transient tachypnoea of the newborn respiratory distress syndrome pneumothorax meconium aspiration syndrome and pneumonia. Pneumomediastinum is uncommon in both infants and children 1 2 . In the neonate pneumomediastinum may be asymptomatic but may also cause significant respiratory distress. We present a case of pneumomediastinum in a neonate in whom the initial chest x-rays CXRs were difficult to interpret. Case presentation We report a male baby born in a peripheral setting at 36 weeks of gestation to a 36 year old primiparous mother whose pregnancy was complicated by breech presentation and premature rupture of membranes at 34 weeks of gestation. Delivery was .
