A diagnostic challenge: investigating suspected tracheobronchial and pharyngoesophageal tears. Are there gold standards?

Pneumomediastinum and surgical emphysema of the neck as a result of blunt chest trauma occurs rarely. We report a case of pneumomediastinum and extensive surgical emphysema of the face and neck due to blunt chest trauma (assault), without evidence of laryngotracheal or pharyngoesophageal tear from the clinical assessment and the radiological examinations. Diagnosis, management, evaluation of investigations and potential mechanisms are discussed. In the presence of suspicious tracheal rupture bronchoscopy is mandatory but not the gold standard to confirm the location of the tear, as seen in our case. In the absence of respiratory compromise, conservative management is appropriate.