A组链球菌下行性坏死性纵隔炎导致的心包填塞：罕见表现的病例报告

Cardiac tamponade due to group a streptococcus descending necrotizing mediastinitis: case report of an unusual presentation.

作者信息

Claveau David, Bériault Marie-Josée

机构信息

Department of Emergency Medicine, Centre de santé et de services sociaux de Trois-Rivières, Centre hospitalier affilié universitaire régional, Trois-Rivières, Quebec, Canada.

Department of Intensive Care Medicine, Centre de santé et de services sociaux de Trois-Rivières, Centre hospitalier affilié universitaire régional, Trois-Rivières, Quebec, Canada.

出版信息

J Emerg Med. 2014 Jul;47(1):12-4. doi: 10.1016/j.jemermed.2014.01.024. Epub 2014 Mar 20.

DOI:10.1016/j.jemermed.2014.01.024

PMID:24657258

Abstract

BACKGROUND

Cardiac tamponade from necrotizing descending mediastinitis is a rare but life-threatening complication of cervicofacial infections.

CASE REPORT

A 49-year-old woman presented in shock with pleuretic chest pain at a small community clinic. She was transferred to our emergency department where cardiac tamponade was diagnosed and drained. Her initial complete blood count and chest radiography suggested a neoplastic process. She, however, was diagnosed with descending necrotizing mediastinitis due to group A Streptococcus. She underwent surgical drainage and recovered uneventfully. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Descending necrotizing mediastinitis can present with cardiac tamponade and a leukemoid reaction mimicking a neoplastic process. Recognizing this entity allows initiation of potentially life-saving treatments.

摘要

背景

坏死性纵隔炎导致的心包填塞是颈面部感染罕见但危及生命的并发症。

病例报告

一名49岁女性在一家小型社区诊所因胸膜性胸痛出现休克。她被转至我们的急诊科，在那里被诊断出心包填塞并进行了引流。她最初的全血细胞计数和胸部X光检查提示为肿瘤性病变。然而，她被诊断为A组链球菌引起的坏死性纵隔炎。她接受了手术引流，恢复顺利。急诊医生为何应了解此情况？：坏死性纵隔炎可表现为心包填塞和类白血病反应，酷似肿瘤性病变。认识到这一实体有助于启动可能挽救生命的治疗。