Departments of Emergency and Surgery, Emergency Surgery and Trauma Surgery Unit, Trauma Center, Maggiore Hospital-Bologna Local Health District, Bologna, Italy.
Front Med. 2013 Sep;7(3):386-8. doi: 10.1007/s11684-013-0278-y. Epub 2013 Jul 15.
A 56-year-old man presented spontaneously to the Emergency Department complaining of facial and neck oedema after assumption of nonsteroidal anti-inflammatory drugs (NSAIDS). The triage nurse assigned the patient to Accident & Emergency (A&E) doctor as probable allergic reaction to NSAIDS. Chest X-ray (CXR), ordered after 24 hours, revealed a huge subcutaneous chest and neck emphysema without clearly visible pneumothorax. Subsequent chest CT scan showed a small left pneumothorax and a large amount of air in the mediastinum. The patient was conservatively treated since he was eupnoeic and hemodynamically stable. The pathophysiology of pneumomediastinum was first described by Macklin in 1939. The Macklin effect involves alveolar ruptures with air dissection along bronchovascular sheaths to the mediastinum. In this case the patient did not report in his history a recent blunt thoracic trauma and the initial suspicion of an allergic reaction has prevented physicians to immediately achieve the correct diagnosis.
一位 56 岁男性因服用非甾体抗炎药（NSAIDs）后出现面部和颈部水肿，自行到急诊科就诊。分诊护士将患者分配给急症医生，疑似 NSAIDs 过敏反应。24 小时后，胸部 X 线（CXR）显示巨大的皮下胸部和颈部气肿，没有明显的气胸。随后的胸部 CT 扫描显示左侧气胸小，纵隔大量积气。由于患者呼吸平稳，血流动力学稳定，因此采用保守治疗。1939 年，Macklin 首次描述了纵隔气肿的病理生理学。Macklin 效应涉及肺泡破裂，空气沿着支气管血管鞘向纵隔分离。在这种情况下，患者在病史中并未报告近期有钝性胸部外伤，最初怀疑过敏反应导致医生未能立即做出正确诊断。
