Buscar en
Radiología (English Edition)
Toda la web
Inicio Radiología (English Edition) Finding the bubble: atypical and unusual extrapulmonary air in the chest
Journal Information
Vol. 63. Issue 4.
Pages 358-369 (July - August 2021)
Download PDF
More article options
Vol. 63. Issue 4.
Pages 358-369 (July - August 2021)
Radiology through images
DOI: 10.1016/j.rxeng.2021.02.005
Finding the bubble: atypical and unusual extrapulmonary air in the chest
Buscando la burbuja: aire torácico extrapulmonar atípico e inusual
D. Varona Porres
Corresponding author

Corresponding author.
, O. Persiva, A.L. Sánchez, L. Cabanzo, E. Pallisa, J. Andreu
Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
Article information
Full Text
Download PDF
Figures (15)
Show moreShow less
Tables (1)
Table 1. Most common causes of ectopic extrapulmonary thoracic air.

To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients.


In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).

Esophageal perforation
Tracheal rupture
Venous air embolism
Bronchopleural fistula
Transdiaphragmatic intercostal hernia
Subcutaneous emphysema

Describir los hallazgos radiológicos y revisar las causas atípicas e inusuales de aire torácico extrapulmonar, incidiendo en la importancia del diagnóstico para el manejo de estos pacientes.


En este artículo revisaremos una serie de casos recogidos en nuestro centro que se manifiestan como aire torácico extrapulmonar, con especial atención a las causas atípicas e infrecuentes. Según su localización anatómica, las clasificaremos en: localización mediastínica (neumomediastino espontáneo con neumorraquis, rotura traqueal, dehiscencia de sutura bronquial en trasplante pulmonar, disección intramucosa esofágica, síndrome de Boerhaave, fístula traqueoesofágica en neoplasia esofágica, perforación bronquial y fístula esofagorrespiratoria por rotura de ganglio linfático, y mediastinitis aguda), localización pericárdica (neumopericardio en neoplasia pulmonar), localización cardiovascular (embolia venosa aérea), localización pleural (fístulas broncopleurales, neumotórax espontáneo en mesotelioma pleural maligno y neoplasia pulmonar primaria, y neumotórax bilateral posbiopsia pulmonar unilateral) y localización en pared torácica (infecciones, hernia intercostal transdiafragmática y enfisema subcutáneo posbiopsia pulmonar).

Palabras clave:
Perforación esofágica
Rotura traqueal
Embolia venosa aérea
Fístula broncopleural
Hernia intercostal transdiafragmática
Enfisema subcutáneo


These are the options to access the full texts of the publication Radiología (English Edition)

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
Article options
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos