Mallinckrodt Institute of Radiology, Saint Louis, MO, USA.
J Thorac Imaging. 2012 Mar;27(2):85-92. doi: 10.1097/RTI.0b013e3182103876.
To analyze the multidetector computed tomography (MDCT) findings of spontaneous pneumomediastinum (PM) to determine whether MDCT can reliably differentiate spontaneous from secondary PM.
A retrospective clinical and chest MDCT analysis of all patients diagnosed with spontaneous PM over an 8-year period was performed. Radiologic comparison was undertaken with patients diagnosed with secondary PM from a central airways defect, esophageal rupture, or recent intervention in the airway or esophagus. The Fisher exact test for independence was used to compare the different MDCT findings between the groups.
A total of 89 patients were analyzed, with 1 secondary PM patient being included in both esophageal and central airways subsets, as the patient had an esophageal balloon-assisted intubation. Thirty-four patients were diagnosed with spontaneous PM. Compared with 28 patients with secondary PM from esophageal pathology, spontaneous PM patients were more likely to have air in the anterior mediastinum (97% vs 61%, P<0.001) and pulmonary interstitial emphysema (57% vs 4%, P<0.001), and less likely to show subdiaphragmatic air (0% vs 32%, P<0.001), pleural effusions (9% vs 61%, P<0.001), and acute pulmonary airspace opacities (14% vs 50%, P=0.003). Similarly, compared with 28 patients with secondary PM from trachea and bronchi pathology, patients with spontaneous PM were more likely to have pulmonary interstitial emphysema (57% vs 25%, P=0.01), and were less likely to show subdiaphragmatic air (0% vs 25%, P=0.002), pleural effusions (9% vs 39%, P=0.005), and acute pulmonary airspace opacities (14% vs 43%, P=0.02).
Spontaneous PM is associated with a favorable clinical course, and it is possible to suggest this clinical diagnosis based on typical MDCT findings and clinical presentation.
分析自发性纵隔气肿（PM）的多层螺旋 CT（MDCT）表现，以确定 MDCT 是否能可靠地区分自发性与继发性 PM。
对 8 年间经 MDCT 诊断为自发性 PM 的所有患者进行回顾性临床和胸部 MDCT 分析。对因中央气道缺陷、食管破裂、气道或食管近期介入而诊断为继发性 PM 的患者进行放射学比较。采用独立性 Fisher 确切概率法比较两组之间的不同 MDCT 发现。
共分析了 89 例患者，其中 1 例继发性 PM 患者同时存在食管和中央气道亚组，因为该患者进行了食管气囊辅助插管。34 例患者被诊断为自发性 PM。与 28 例因食管病变引起的继发性 PM 患者相比，自发性 PM 患者纵隔前部积气（97%比 61%，P<0.001）和肺间质积气（57%比 4%，P<0.001）更常见，膈下积气（0%比 32%，P<0.001）、胸腔积液（9%比 61%，P<0.001）和急性肺空气腔混浊（14%比 50%，P=0.003）较少见。同样，与 28 例因气管和支气管病变引起的继发性 PM 患者相比，自发性 PM 患者肺间质积气更常见（57%比 25%，P=0.01），膈下积气（0%比 25%，P=0.002）、胸腔积液（9%比 39%，P=0.005）和急性肺空气腔混浊（14%比 43%，P=0.02）较少见。
自发性 PM 与良好的临床病程相关，根据典型的 MDCT 表现和临床表现，有可能提示这种临床诊断。
