Radiological Cases of the Month

A 13-year-old boy was admitted to the hospital with a two-day history of polyuria, vomiting, and weakness. His paternal grandparents had diabetes of adult onset. Although two weeks previously he had weighed 43.6 kg at a prefootball physical examination, his weight at admission was 38.2 kg. He was tachypneic (36 breaths per minute) and hyperpneic. His skin and mucous membranes were dry, and soft tissue in his left axilla was crepitant. A systolic crunch was auscultated at the cardiac apex. The initial blood glucose level was 71.3 mmol/L, while the level of glucose in the urine was greater than 55.5 mmol/L, and the urine ketone level was greater than 13.7 mmol/L. Arterial blood pH was 7.19, with a carbon dioxide pressure of 23 mm Hg and an oxygen pressure of 126 mm Hg. Chest roentgenograms (Figure) were obtained.

Denouement and Discussion 

Pneumomediastinum and Subcutaneous Emphysema Caused by Diabetic Hyperpnea