Assessment of spontaneous pneumomediastinum: Experience with 12 patients
Assessment of spontaneous pneumomediastinum: Experience with 12 patients
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DOI：
10.1016/s0003-4975(03)00027-4
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发表时间：
2003-06-01
影响因子：
4.6
通讯作者：
Velly, JF
中科院分区：
文献类型：
--
作者：
Jougon, JB;Ballester, M;Velly, JF
背景。本研究的目的是报告一系列有胸廓高压病史的年轻、高大、瘦弱患者中发生的自发性纵隔气肿，并分析此类患者所需的评估。方法。对单中心系列进行回顾性研究并回顾 1980 年至 2002 年的文献。结果。 1996年12月至2002年1月期间，有12名患者（平均年龄25岁；平均身高172厘米；平均体重63公斤）因自发性纵隔气肿入院。在所有患者中，咳嗽或剧烈用力导致的高胸内压是诱发因素。最常见的主诉是急性胸痛、乏力和皮下气肿。进行了以下评估： 12 名患者中的 12 名进行了胸部 X 线检查 (12/12)； 8月12日计算机断层扫描（CT）； 7/12 支气管镜检查； 6/12 食管镜检查； 2/12 食管造影。结果一直很顺利，没有复发。住院时间为 0 至 6 天。 Medline 研究显示，文章主要由病例报告组成。两篇文章仅报告了分别包含 25 例和 36 例的多中心系列。在我们的系列或文献综述中均未发现器官穿孔。结论。自发性纵隔气肿发生在肺间质肺泡破裂后。气体向肺门和纵隔的剥离是由急性高胸内压引起的。它主要影响年轻人，这就是我们系列中的情况。内窥镜胸部评估可能存在风险，而且并不总是必要的。如果对食管穿孔的诊断有疑问，应进行胸部CT或食管造影检查。 (Ann Thorac Surg 2003;75:1711-4) (C) 2003 年，胸外科医师协会。
Background. The aim of this study is to report a series of spontaneous pneumomediastinum in a population of young, tall, and thin patients with a history of thoracic hyper pressure, and to analyze the assessment required in such patients.Methods. A retrospective study of an unicentric series and a review of the literature from 1980 to 2002 were performed.Results. Between December 1996 and January 2002, 12 patients (mean age, 25 years old; mean height, 172 cm; and mean weight, 63 kg) were admitted with spontaneous pneumomediastinum. In all patients, high intrathoracic pressure by cough or acute effort was the precipitating factor. Most frequent complaints were acute chest pain, asthenia, and subcutaneous emphysema. The following assessment was performed: chest roentgenogram in 12 of 12 patients (12/12); computer tomography (CT) scan in 8/12; bronchoscopy in 7/12; esophagoscopy in 6/12; esophagography in 2/12. Outcome was always uneventful without any recurrence. Hospital stay ranged from 0 to 6 days. The Medline research revealed that articles consist mainly of case reports. Two articles only report a multicentric series of 25 and 36 cases, respectively. No organ perforation was found either in our series or in our review of the literature.Conclusions. Spontaneous pneumomediastinum follows alveolar rupture in the pulmonary interstitium. The dissection of gas towards the hilum and mediastinum is produced by an episode of acute high intrathoracic pressure. It affects mostly young people, and this is the case in our series. Endoscopic thoracic assessment may be risky and is not always necessary. Chest CT or esophageal contrast study should be performed in case of diagnostic doubt of esophageal perforation. (Ann Thorac Surg 2003;75:1711-4) (C) 2003 by The Society of Thoracic Surgeons.