Macia Ivan, Moya Juan, Ramos Ricard, Morera Ricard, Escobar Ignacio, Saumench Josep, Perna Valerio, Rivas Francisco
Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
Eur J Cardiothorac Surg. 2007 Jun;31(6):1110-4. doi: 10.1016/j.ejcts.2007.03.008. Epub 2007 Apr 8.
Spontaneous pneumomediastinum is characterized by the presence of interstitial air in the mediastinum without any apparent precipitating factor. The purpose of this study is to review and discuss our experience with this condition.
A descriptive, retrospective study of 41 cases--34 men (83%) and 7 women (17%)--treated at our hospital for spontaneous pneumomediastinum from January 1990 through June 2006.
The mean age of the patients was 21 years (range, 14-35 years). Notably, 22% of patients had a prior history of asthma. No precipitating factor was identified in 51% of cases while onset was associated with physical effort in 12%. Chest pain (85%) and dyspnea (49%) were the most common symptoms. Subcutaneous emphysema, which presented in 71% of patients, was the most common sign. Pneumomediastinum was diagnosed by plain chest radiography in all cases. In certain cases, a computed tomography scan of the chest, contrast-enhanced swallow, or bronchoscopy was performed. All patients were admitted to the hospital with good progress and no instances of morbidity or mortality. Treatment included analgesia, rest, and/or initial oxygen therapy. The mean length of hospital stay was 5 days (range, 1-9 days) with only one case of early recurrence, which was resolved satisfactorily.
Spontaneous pneumomediastinum is a benign process primarily affecting young men. Despite its low incidence, spontaneous pneumomediastinum should be considered in the differential diagnosis of acute chest pain because it requires a high index of suspicion. Patients with spontaneous pneumomediastinum respond well to medical treatment, with no recurrence in the great majority of cases.
自发性纵隔气肿的特征是纵隔内存在间质气肿，且无任何明显的诱发因素。本研究的目的是回顾和讨论我们对这种疾病的治疗经验。
对1990年1月至2006年6月期间在我院接受治疗的41例自发性纵隔气肿患者进行描述性回顾性研究，其中男性34例（83%），女性7例（17%）。
患者的平均年龄为21岁（范围14 - 35岁）。值得注意的是，22%的患者有哮喘病史。51%的病例未发现诱发因素，12%的病例发病与体力活动有关。胸痛（85%）和呼吸困难（49%）是最常见的症状。皮下气肿在71%的患者中出现，是最常见的体征。所有病例均通过胸部X线平片诊断为纵隔气肿。在某些情况下，还进行了胸部计算机断层扫描、吞咽造影或支气管镜检查。所有患者入院后病情进展良好，无发病或死亡病例。治疗包括止痛、休息和/或初始氧疗。平均住院时间为5天（范围1 - 9天），仅有1例早期复发，经妥善处理后得到解决。
自发性纵隔气肿是一种主要影响年轻男性的良性疾病。尽管其发病率较低，但在急性胸痛的鉴别诊断中应考虑到自发性纵隔气肿，因为它需要高度的怀疑指数。自发性纵隔气肿患者对药物治疗反应良好，绝大多数病例无复发。
