Beynon Fenella, Mearns Stacey
Obstetrics and Gynaecology Department, Homerton University Hospital, London, UK.
BMJ Case Rep. 2011 Oct 20;2011:bcr0720114556. doi: 10.1136/bcr.07.2011.4556.
A young, previously well primigravida presented a few hours after a short labour with sudden onset chest pain, shortness of breath and odynophagia. She had subcutaneous emphysema but did not have significant cardiorespiratory compromise. She was found to have a spontaneous pneumomediastinum, likely secondary to raised intrathoracic pressure during labour. Similar cases have been reported previously, however there are often risk factors associated such as pre-existing lung disease and illicit drug use for which this patient did not have a significant history. The patient made a speedy recovery without requiring invasive management, as is the case for most patients documented in the literature. Consideration should be given to subsequent labours for this patient to minimise excessive intrathoracic pressure, however recurrence is rarely documented. This case is useful for healthcare professionals in assessing patients with chest pain as a reminder that unusual presentations can be diagnosed through thorough history and examination.
一名年轻的初产妇，此前身体状况良好，在经历短暂分娩数小时后，突然出现胸痛、呼吸急促和吞咽痛。她有皮下气肿，但没有明显的心肺功能损害。经检查发现她患有自发性纵隔气肿，可能是分娩期间胸腔内压力升高所致。此前曾有过类似病例的报道，然而通常存在一些相关的风险因素，如既往肺部疾病和非法药物使用史，而该患者并无此类显著病史。该患者迅速康复，无需进行侵入性治疗，文献中记载的大多数患者也是如此。对于该患者的后续分娩，应考虑尽量减少胸腔内压力过高的情况，不过复发情况鲜有记载。这个病例对医疗保健专业人员评估胸痛患者很有帮助，提醒他们通过全面的病史询问和体格检查可以诊断出不寻常的病症表现。
