Pneumomediastinum diagnosed from a remote tele-ICU center?

Keith Azevedo, Brian T. Wessman

Research output: Contribution to journalArticlepeer-review


Background: The propagation of remote “tele-medicine” has allowed intensivists (and other medical professions) to expand their ability to provide critical care medicine services to intensive care units (ICUs). The physical exam is a pertinent skill that all providers learn early in their medical careers. Key components of the physical exam can help a clinician narrow the differential diagnosis. Even with modern moni-toring devices and high-powered imaging, it is hard to replicate the physical exam on a critical care patient from a tele-medicine center. Case presentation: An experienced intensivist working in a telemedicine (Tele-ICU) center reviewed the daily chest radiograph on a patient with a complex prolonged ICU course. The ra-diograph was immediately recognized as being concerning for an acute case of pneumomedias-tinum in a patient with recent tracheostomy manipulation. However, the intensivist was un-able to corroborate his suspicions with a good physical exam as the differential diagnosis list was explored. Conclusions: Acute pneumomediastinum is a severe disease process arising from numerous etiologies that can be life threatening. This disease process can often times be diagnosed from plain chest radiography alone. However remote telemedicine patient care should never super-sede a direct bedside physical exam. Every good clinician knows that the fundamental physical exam truly is fundamental.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalCritical Care and Shock
Issue number1
StatePublished - 2021


  • Chest radiography
  • Critical care medicine
  • Physical exam
  • Pneumomediastinum
  • Tele-ICU
  • Telemedicine


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