Koullias George J, Korkolis Dimitris P, Wang Xu Jie, Hammond Graeme L
Section of Cardiothoracic Surgery, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.
Eur J Cardiothorac Surg. 2004 May;25(5):852-5. doi: 10.1016/j.ejcts.2004.01.042.
Spontaneous pneumomediastinum (SPM) is an uncommon, benign, self-limited disorder that usually occurs in young adults without any apparent precipitating factor or disease. The purpose of this study was to review our experience in dealing with this entity and detail a reasonable course of assessment and management.
A retrospective case series was conducted to identify adult patients with SPM who were diagnosed and treated in a single institution between 1993 and 2000.
Twenty-four patients were identified who included 18 men and 6 women with a mean age of 17.5 years. Acute onset chest pain was the predominant symptom at presentation. Only half of the patients developed clinically evident subcutaneous emphysema. The most frequent precipitating factor was a history of illegal drug abuse seen in 25% of patients. Other factors included asthmatic bronchospasm, physical activity and violent coughing or vomiting. Chest radiography and computerized tomography (CT) were diagnostic in all cases with CT scan revealing six cases with associated pulmonary abnormalities. Esophagogram and flexible bronchoscopy were selectively used. Twelve patients (50%) were admitted to the hospital. Their mean hospital stay was 2 days. All patients were conservatively treated. In a follow-up of 3-10 years no complications or recurrences were observed.
SPM follows alveolar rupture in the pulmonary interstitium. It shows a rising incidence in young drug users. It has a wide range of clinical features necessitating a high index of suspicion. Chest X-ray and CT scan should be always performed. Hospitalization and aggressive approach should be limited. SPM responds well to conservative treatment and follows a benign natural course.
自发性纵隔气肿（SPM）是一种罕见的、良性的、自限性疾病，通常发生于年轻成年人，无任何明显的诱发因素或疾病。本研究的目的是回顾我们处理该疾病的经验，并详细阐述合理的评估和管理过程。
进行一项回顾性病例系列研究，以确定1993年至2000年间在单一机构诊断和治疗的成年SPM患者。
共确定了24例患者，其中男性18例，女性6例，平均年龄17.5岁。急性胸痛是就诊时的主要症状。只有一半的患者出现临床上明显的皮下气肿。最常见的诱发因素是非法药物滥用史，见于25%的患者。其他因素包括哮喘性支气管痉挛、体力活动以及剧烈咳嗽或呕吐。胸部X线和计算机断层扫描（CT）在所有病例中均具有诊断价值，CT扫描显示6例伴有肺部异常。选择性地使用了食管造影和纤维支气管镜检查。12例患者（50%）入院。他们的平均住院时间为2天。所有患者均接受保守治疗。在3至10年的随访中，未观察到并发症或复发。
SPM继发于肺间质的肺泡破裂。在年轻吸毒者中的发病率呈上升趋势。它具有广泛的临床特征，需要高度怀疑。应始终进行胸部X线和CT扫描。住院治疗和积极的治疗方法应受到限制。SPM对保守治疗反应良好，病程呈良性。
