Munch-Petersen L, Kjaergård H K
Thoraxkirurgisk afdeling RT, Rigshospitalet, København.
Ugeskr Laeger. 1992 Jul 13;154(29):2004-7.
Pneumomediastinum is a rare pathological condition with air in the mediastinum outside the trachea and oesophagus. The etiology may be spontaneous/resulting from exertion, traumatic, iatrogenic or it may be due to inflammation, neoplasm or perforation of a hollow abdominal organ. In pneumomediastinum resulting from exertion, a pressure gradient occurs and this causes rupture of marginally situated pulmonary alveoli. Air escapes from the alveoli into the perivascular adventitia and dissects its way along the vessels to the mediastinum. The commonest symptoms are pain in the thorax in 80-90% of the patients, followed by sensation of oppression and dysphagia. Stethoscopic examination reveals crepitation synchronous with pulse and respiration in half of the cases. The diagnosis is verified by radiographic examination of the thorax where air can be seen as vertical radio-translucent regions in the mediastinum and along the borders of the heart. Patients with pneumomediastinum should be admitted to hospital for investigation as treatment of a possible basic condition, e.g. rupture of the oesophagus or bronchus, is important. In uncomplicated cases, the mediastinal emphysema disappears in the course of a week. Mediastinotomy with incisions for relief of pressure may prove necessary.
纵隔气肿是一种罕见的病理状况，气管和食管外的纵隔内存在气体。病因可能是自发性的/由用力所致、创伤性的、医源性的，也可能是由于炎症、肿瘤或中空腹部器官穿孔引起。在用力导致的纵隔气肿中，会出现压力梯度，这会导致边缘部位的肺泡破裂。空气从肺泡逸出进入血管周围外膜，并沿血管进入纵隔。最常见的症状是80 - 90%的患者会出现胸痛，其次是压迫感和吞咽困难。半数病例听诊可闻及与脉搏和呼吸同步的捻发音。通过胸部X线检查可确诊，纵隔内及心脏边缘可见垂直的透光区。纵隔气肿患者应住院检查，因为治疗可能的基础疾病，如食管或支气管破裂，很重要。在无并发症的情况下，纵隔气肿在一周内会消失。可能需要进行纵隔切开术并做切口以减轻压力。
