CLINICAL HISTORY.—This 11-year-old white girl was admitted to the University of Virginia Hospital with a history of asthma since infancy. She had three prior admissions for pulmonary infections, sino- bronchitis, and atopic eczema. The present admission was occasioned by a severe asthmatic attack of three days' duration.
At the time of physical examination, the patient was in moderate respiratory distress with evidence of intercostal retraction and use of accessory muscles of inspiration. The chest was hyperexpanded with high pitched inspiratory and expiratory changes heard throughout both lungs. Chest radiographs were obtained.
DENOUEMENT AND DISCUSSION
SPONTANEOUS PNEUMOMEDIASTINUM IN ASTHMA
The lateral projection of the chest shows the classic appearance of pneumomediastinum, with the anterior and interior surfaces of the thymus outlined by air. The air also outlines the anterior surface of the heart and extends in streaks into the superior mediastinal soft tissues. The left mediastinal pleura is slightly displaced laterally,