MediAI

A Radiology Case Review for Emergency Physicians, Radiologists, and Thoracic Specialists Introduction Acute chest pain following severe vomiting is a clinical presentation that requires immediate attention. Although spontaneous pneumomediastinum (SPM) is generally considered a benign and self-limiting condition, it may mimic life-threatening disorders such as esophageal perforation (Boerhaave syndrome), tracheobronchial injury, acute coronary syndrome, or pulmonary embolism. This case involves a 29-year-old man who presented with severe chest pain after repeated episodes of forceful vomiting. Chest radiography demonstrated subtle mediastinal and cervical air, while chest CT confirmed pneumomediastinum with associated cervical emphysema and a small left pneumothorax. Subsequent esophagoscopy and bronchoscopy excluded esophageal and tracheobronchial perforation, supporting the diagnosis of spontaneous pneumomediastinum secondary to the Macklin effect . This review summarizes the pathoph...

Adult Coarctation of the Aorta: The CT Diagnosis Hidden Behind Chest Pain and Hypertension Introduction A 41-year-old man arrives at the emergency department complaining of persistent chest discomfort. His electrocardiogram is unremarkable. Cardiac enzymes are normal. The initial suspicion of acute coronary syndrome begins to fade. Then a careful physical examination reveals a critical clue. The blood pressure measured in the upper extremities is significantly higher than in the lower extremities. What initially appeared to be a routine chest pain evaluation suddenly becomes a diagnostic challenge. Subsequent CT angiography reveals a severe narrowing of the thoracic aorta consistent with coarctation of the aorta, a congenital cardiovascular anomaly often diagnosed during infancy but occasionally overlooked until adulthood. This case highlights one of the most important lessons in cardiovascular imaging: Not all chest pain originates from the coronary arteries. Some of the most clinical...