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 Table of Contents  
IMAGES IN CARDIOTHORACIC TRAUMA
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 40

Gingko leaf sign: Radiographic manifestation of extensive subcutaneous emphysema


Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India

Date of Web Publication24-Dec-2020

Correspondence Address:
Vikas Bhatia
Assistant Professor, Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jctt.jctt_4_20

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How to cite this article:
Muniraju M, Bhatia V. Gingko leaf sign: Radiographic manifestation of extensive subcutaneous emphysema. J Cardiothorac Trauma 2020;5:40

How to cite this URL:
Muniraju M, Bhatia V. Gingko leaf sign: Radiographic manifestation of extensive subcutaneous emphysema. J Cardiothorac Trauma [serial online] 2020 [cited 2021 Apr 12];5:40. Available from: https://www.jctt.org/text.asp?2020/5/1/40/304866



A middle-aged male presented to the trauma center with an alleged history of a road traffic accident and difficulty in breathing. His general physical examination revealed the crepitus of the chest and abdominal wall. His vitals were stable, and showed pulse oximeter no derangement in oxygen saturation. Bedside focused assessment with sonography in trauma revealed near-complete back-reflection of acoustic signals with impaired intra-abdominal and intra-thoracic evaluation. The patient was subjected for radiography, which revealed extensive, linear, hyper lucent areas seen dissecting along the subcutaneous and intermuscular plane extending from scalp till bilateral knee joints, suggestive of massive subcutaneous emphysema. Chest radiograph [Figure 1]a depicted fibers of pectoralis muscle outlined by the air simulating the arborizing pattern of veins on Gingko leaf, thereby resulting in “Gingko leaf sign.” Multiple rib fractures are also noted on chest radiographs which were likely the cause of massive subcutaneous emphysema. Subsequently, obtained chest computed tomography [Figure 1]b showed an additional feature of pneumo-mediastinum. In literature, it is described as the development of massive subcutaneous emphysema in association with rib fractures. Simple percutaneous chest tube placement in the emergency area relieved the respiratory discomfort. Further, the patient was taken up for poly-trauma management.
Figure 1: Chest radiograph (a) showing fibres of pectoralis muscle outlined by the air simulating the arborizing pattern of veins on Gingko leaf (a) thereby resulting in “Gingko leaf sign.” Chest computed tomography (b) confirming the subcutaneous emphysema with additional feature of pneumo-mediastinum

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