Neonatal Pneumomediastinum and the Spinnaker-Sail Sign

A male infant was born at 40 weeks of gestation by vacuum-assistedvaginal delivery. Mild respiratory distress with expiratory gruntingand subcostal retraction was noted 1 hour after birth. Arterial oxygensaturation remained at more than 95% without the administration ofsupplemental oxygen. Chest radiography performed 6 hours after birth showed the spinnaker-sail sign, consisting of a large,wedge-shaped opacity extending from the right hemidiaphragm to thesuperior mediastinum, representing thymic tissuedisplaced from its usual location by a collection of gas under pressure. Axial computed tomography of the chest revealed airtrapped between the pericardial sac and the thymus, confirming adiagnosis of anterior pneumomediastinum. Named for itsvisual resemblance to the headsail of a boat, the spinnaker-sail signoccurs with a spontaneous anterior pneumomediastinum and usuallyresolves without specific treatment. After being observed for clinicaland radiographic improvement for 3 weeks, the infant was dischargedhome in good condition. Jorge Correia-Pinto, M.D., Ph.D.
Tiago Henriques-Coelho, M.D., Ph.D.
Hospital de Sao Joao, Porto, Portugal