Kerns E S, Alobaidi S A, Roayaie K, Obhrai J S
Departments of Nephrology, Hypertension, & Transplantation, Oregon Health & Science University, Portland, Oregon.
Transplant Proc. 2013 Sep;45(7):2811-4. doi: 10.1016/j.transproceed.2013.02.143.
Chest pain in kidney transplant recipients can signify a life-threatening condition.
A patient with polycystic kidney disease who underwent living donor kidney transplantation with open bilateral native nephrectomy developed acute substernal chest pain 10 days post-transplantation. History, physical, and diagnostic studies identified no cardiac or pulmonary causes for the pain, but radiography showed mediastinal air. No vascular or thoracic injury explained the development of the pneumomediastinum. After 1 day on oxygen, the chest pain symptoms resolved. Repeat x-rays showed resolution of the pneumomediastinum.
Pneumomediastinum resulting from air migrating from the abdominal cavity to the thorax has not been described after open removal of diseased abdominal organs. This case illustrates that creation of a potential space in the abdominal cavity can be associated with the development of pneumomediastinum.
Conservative measures were sufficient to resolve the pneumomediastinum and symptoms in this patient.
肾移植受者出现胸痛可能意味着一种危及生命的状况。
一名患有多囊肾病的患者接受了活体供肾肾移植及开放性双侧自体肾切除术,术后10天出现急性胸骨后胸痛。病史、体格检查及诊断性检查均未发现引起疼痛的心脏或肺部原因,但影像学检查显示纵隔积气。没有血管或胸部损伤可以解释纵隔气肿的发生。吸氧1天后,胸痛症状缓解。复查X线显示纵隔气肿消失。
在开放性切除患病腹部器官后,尚未有因空气从腹腔迁移至胸腔导致纵隔气肿的相关描述。该病例表明,腹腔内潜在腔隙的形成可能与纵隔气肿的发生有关。
保守措施足以解决该患者的纵隔气肿及症状。