Harrod Christopher C, Boykin Robert E, Kim Young J
Orthopaedics, Massachusetts General Hospital, Boston, MA, USA.
J Pediatr Orthop. 2010 Jul-Aug;30(5):455-9. doi: 10.1097/BPO.0b013e3181df44b6.
Epidural pneumatosis and pneumomediastinum are rare findings. Reports in children are exceedingly rare. Abnormal neurologic findings have yet to be reported.
We report on the case of a 7-year-old girl who was diagnosed with epidural pneumatosis with signs of neurologic compression in the setting of Haemophilus influenzae upper and lower respiratory infection. After urgent direct laryngoscopy, bronchoscopy, esophagoscopy, and pharyngeal biopsy was carried out, CT scan of the chest revealed extensive pneumomediastinum tracking along vessels throughout the neck and chest in addition to epidural pneumatosis from C6 to T5. Upper motor neuron findings were present. Broad spectrum antibiotics were administered, and interval neurologic examination and repeat CT scans showed resolution of abnormal neurologic exam in addition to epidural pneumatosis dissipation.
Rapid clinical improvement was noted on broad spectrum intravenous antibiotics with extubation on postoperative day one. She was discharged home on oral augmentin on postoperative day 4 with intact neurologic examination. At 11 month follow-up, she remained symptom-free with normal neurologic examination and unremarkable cervical and thoracic spine radiographs.
Resolution of clinical and radiographic findings is possible with conservative treatment.
IV.
硬膜外积气和纵隔积气是罕见的发现。儿童病例报告极为罕见。尚未有异常神经系统表现的报道。
我们报告一例7岁女孩，在患有流感嗜血杆菌引起的上、下呼吸道感染的情况下，被诊断为硬膜外积气并伴有神经受压体征。在紧急进行直接喉镜检查、支气管镜检查、食管镜检查和咽部活检后，胸部CT扫描显示除了从C6到T5的硬膜外积气外，还有广泛的纵隔积气沿颈部和胸部的血管蔓延。存在上运动神经元表现。给予广谱抗生素治疗，定期进行神经系统检查和重复CT扫描显示异常神经系统检查结果消失，硬膜外积气消散。
术后第一天静脉给予广谱抗生素后临床迅速改善并拔除气管插管。术后第4天口服奥格门汀出院，神经系统检查正常。在11个月的随访中，她无症状，神经系统检查正常，颈椎和胸椎X线片无异常。
保守治疗可使临床和影像学表现得到缓解。
IV级。
