Miura Hiroyuki, Taira Osamu, Hiraguri Shunsuke, Ohtani Keiji, Kato Harubumi
Department of Thoracic Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2003 Jun;9(3):188-91.
The clinical features of pneumomediastinum are clarified.
Eight patients with pneumomediastinum, caused by other than trauma or operative, diagnostic, or therapeutic trouble (medical pneumomediastinum), were studied retrospectively.
There were seven men and one woman with an average age of 17.5 years. The incidence was about 1:320 in thoracic surgical inpatients. The causes were bronchial asthma in three patients, physical exertion in one, and forced swallowing in one. There were three spontaneous cases. The chief complaints were dyspnea in five patients including three patients with bronchial asthma, chest pain in two, and pharyngeal pain in one. Subcutaneous emphysema was observed in all patients. Hamman's sign was audible in only one patient. Roentgenologically, subcutaneous emphysema was observed in all patients. Pneumomediastinum parallel to the heart was observed in five patients. The continuous diaphragm sign was detected in three patients. Five patients were prohibited from eating and drinking excluding those with pneumomediastinum due to bronchial asthma, considering the esophageal origin. Prophylactic antibiotics were prescribed for all patients. Pneumomediastinum improved within 7 days in all patients. The mean length of hospitalization was 7.8 days, ranging from 4 to 13 days.
In consideration of air of the esophageal origin, non per oral was prescribed. With the prevention of mediastinitis using antibiotics, all patients recovered. Emergency endoscopic examination was unnecessary.
阐明纵隔气肿的临床特征。
回顾性研究8例非创伤、手术、诊断或治疗相关原因（医源性纵隔气肿）导致的纵隔气肿患者。
7例男性，1例女性，平均年龄17.5岁。在胸外科住院患者中的发病率约为1:320。病因包括3例支气管哮喘、1例体力活动、1例强迫吞咽。有3例为自发性病例。主要症状为5例患者出现呼吸困难，其中3例为支气管哮喘患者，2例胸痛，1例咽痛。所有患者均观察到皮下气肿。仅1例患者可闻及Hamman征。影像学检查显示，所有患者均有皮下气肿。5例患者可见与心脏平行的纵隔气肿。3例患者检测到连续膈征。考虑到食管源性，除支气管哮喘导致纵隔气肿的患者外，5例患者被禁止进食和饮水。所有患者均给予预防性抗生素治疗。所有患者的纵隔气肿在7天内均有改善。平均住院时间为7.8天，范围为4至13天。
考虑到食管源性空气，给予非经口饮食。通过使用抗生素预防纵隔炎，所有患者均康复。无需进行急诊内镜检查。
