BMJ:自发性纵隔气肿-案例报道

2017-02-16 xing.T MedSci原创

自发性纵隔气肿在急性发作时给予支持治疗(控制潜在的哮喘、镇痛、休息和氧疗)通常会很快缓解。不需要预防性抗生素治疗除非有食管破裂的证据。虽然通常不易复发,重点应该是对任何潜在的病因因素,如哮喘控制不佳,实现最佳控制。

患者为一名16岁的男孩,因橄榄球比赛后出现呼吸困难和颈部肿胀疼痛而就诊。其颈部或胸部没有任何创伤。该患者有哮喘病史,最近有上呼吸道感染。沙丁胺醇不能缓解患者呼吸困难,比赛后其颈部肿胀和呼吸困难逐步恶化。X光片有何异常(如图1所示),诊断是啥?


图1 后前位胸片

答案
X光片显示纵隔内有空气。

讨论
病人在描述肿胀后开始被医生关注。临床上怀疑外科性气肿,在他因脖子“噼里啪啦”的感觉而就诊时。X光片上没有看到气胸,但有一薄层空气围绕在心脏周围,颈部软组织中的空气证实为纵隔积气(如图2所示)。鼻内窥镜和CT扫描没有发现气管或食管损伤(如图3所示)。通过排除,诊断为自发性纵隔气肿。症状和体征在72小时内消退,该患者完全康复,三周后返回赛场。


图2心脏周围的空气(箭头),以及在锁骨上区软组织中的空气


图3 颈部(A,B)和胸部(C)CT图像显示空气弥漫在整个纵隔。CT扫描显示无气管或食管损伤

讨论
自发性纵隔气肿与哮喘控制不佳、上呼吸道感染等有关。该病主要影响青少年和年轻的成年人。
自发性纵隔气肿在急性发作时给予支持治疗(控制潜在的哮喘、镇痛、休息和氧疗)通常会很快缓解。不需要预防性抗生素治疗除非有食管破裂的证据。虽然通常不易复发,重点应该是对任何潜在的病因因素,如哮喘控制不佳,实现最佳控制。

原始出处:

Oliver M J Gittoes,et al. Breathlessness and neck swelling after a rugby game.BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j311

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    2017-05-30 gaoxiaoe
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    2017-02-18 sodoo
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    2017-02-17 忠诚向上

    好好努力

    0