The chest x-ray shows streaky lucency outlining the great vessels of the neck (tubular artery sign) & air in the soft tissue of right supraclavicular area. The findings are indicative of pneumomediastinum & as such patient should be thoroughly assessed for a cause (thoracic cage fracture, aero-digestive tract injury). Raised airway pressures causing alveolar rupture in asthma exacerbation & recreational drug use like cocaine snorting are other causes of pneumomediastinum.

A sinister cause for above presentation not to be missed is oesophageal rupture.

This stable patient was managed conservatively.