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Posteroanterior chest x-ray: A1) Radiological findings of pneumomediastinum such as gas around ascending aorta (arrows), gas in neck tissues and subcutaneous emphysema (arrowhead) and Naclerio V sign. A2) Normal chest radiograph on twelfth postoperative day. B1) Earth-heart Sign: The cardiac silhouette appears to be flattened. This sign reflects cardiac compression caused by tension pneumomediastinum. B2) Normal cardiac silhouette on twelfth postoperative day after gas drainage.