Fujimoto Katsunada, Matsunaga Rika, Yamamoto Fumio, Kuraki Takashige, Shiraishi Motokimi, Watanabe Kentaro
Department of Medicine, Division of Respiratory Medicine, Fukuoka University School of Medicine.
Nihon Kokyuki Gakkai Zasshi. 2004 Oct;42(10):909-13.
A 17 year-old youth presented with swelling of both sides of neck after a fight with a friend. He had been sick with an upper respiratory tract infection for a few days with frequent coughing. Chest radiography showed subcutaneous and mediastinal emphysema. Neck CT at the level of C7 showed air around the trachea, extending to the subcutaneous tissue and the epidural space through the intervertebral foramen. His height was 180 cm and his weight 55 kg, and he had a 181 cm arm span. He had scoliosis and arachnodactyly, and ultrasonic cardiography demonstrated mitral and tricuspid regurgitation. These findings agreed partially with the clinical criteria of Marfan syndrome. Thus, forme fruste of Marfan syndrome was suspected. A rapid rise of airway pressure induced by a coughing attack and loud shouting during the fight probably caused the laceration of the connective tissue in the airway, resulting in mediastinal and epidural emphysema. In this case report, CT at the C7 level satisfactorily identified air in the mediastinum extending to the epidural space through intervertebral foramen.
一名17岁青年在与朋友打架后出现双侧颈部肿胀。他患了上呼吸道感染几天，咳嗽频繁。胸部X线检查显示皮下和纵隔气肿。C7水平的颈部CT显示气管周围有气体，通过椎间孔延伸至皮下组织和硬膜外间隙。他身高180厘米，体重55公斤，臂展181厘米。他有脊柱侧弯和蜘蛛指，超声心动图显示二尖瓣和三尖瓣反流。这些发现部分符合马方综合征的临床标准。因此，怀疑为马方综合征顿挫型。打架时咳嗽发作和大声呼喊引起的气道压力迅速升高可能导致气道结缔组织撕裂，从而导致纵隔和硬膜外气肿。在本病例报告中，C7水平的CT令人满意地识别出纵隔内通过椎间孔延伸至硬膜外间隙的气体。
