Patnaik Ashis, Mahapatra Ashok Kumar
Department of Trauma and Emergency, All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India.
Department of Neurosurgery, All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India.
Surg Neurol Int. 2014 Aug 11;5:126. doi: 10.4103/2152-7806.138517. eCollection 2014.
Intraosseous collections of air are rare in comparison to the extra-osseous collection. Pneumoceles are rare entities defined as enlarged pneumatized air sinuses or air cells, with focal or diffuse thinning of the surrounding bony walls. They may affect mastoid air cells and any of the paranasal sinuses.
We report a rare case of extensive mastoid pneumatisation in a young male patient. Patient was completely asymptomatic with swelling as the main complaint. Short history of development raised suspicion for a malignant lesion. Cholesteatoma was also taken as a differential diagnosis. However, computed tomography (CT) scan showed gross expansion of mastoid air cells with no lesion inside it. The walls of mastoid were markedly thinned out, making the diagnosis as pneumocele. In spite of a large swelling, conservative treatment was adopted in view of no symptoms and was advised follow-up regularly to detect any possible complications.
Our case was interesting in that rare mastoid pneumoceles can be totally asymptomatic and can be large enough to raise concern for a malignant lesion. Literature shows that such mastoid pneumocele are symptomatic and require active intervention. Our asymptomatic mastoid pneumocele is a rare instance requiring no surgical procedure and was followed-up. Overall, such lesions should be treated as normal variants of physiological mastoid.
与骨外积气相比，骨内积气较为罕见。肺气囊肿是一种罕见的病变，定义为气化的鼻窦或气房扩大，周围骨壁有局灶性或弥漫性变薄。它们可累及乳突气房和任何鼻窦。
我们报告了一例年轻男性患者广泛乳突气化的罕见病例。患者完全无症状，主要表现为肿胀。病程短引发了对恶性病变的怀疑。胆脂瘤也被列为鉴别诊断。然而，计算机断层扫描（CT）显示乳突气房明显扩张，内部无病变。乳突壁明显变薄，诊断为肺气囊肿。尽管肿胀较大，但鉴于无症状，采取了保守治疗，并建议定期随访以发现任何可能的并发症。
我们的病例有趣之处在于，罕见的乳突肺气囊肿可以完全无症状，且可能大到足以引发对恶性病变的担忧。文献表明，此类乳突肺气囊肿有症状，需要积极干预。我们的无症状乳突肺气囊肿是一个罕见的无需手术的病例，并进行了随访。总体而言，此类病变应被视为生理性乳突的正常变异。
