Gorgas Diane L, Miller Brian
Department of Emergency Medicine, The Ohio State University's Wexner Medical Center, Columbus, Ohio.
Department of Emergency Medicine, The Ohio State University's Wexner Medical Center, Columbus, Ohio.
Am J Emerg Med. 2015 Feb;33(2):310.e1-3. doi: 10.1016/j.ajem.2014.08.014. Epub 2014 Aug 8.
The differential diagnosis for a paratracheal air collection includes Zenker diverticulum, tracheal diverticulum, apical herniation of the lung, and pneumomediastinum. In the setting of trauma, pneumomediastinum is traditionally regarded as an alarm sign that warrants investigation for tracheal or esophageal rupture,both highly morbid conditions.
A patient presented to the emergency department with neck pain several hours after being involved in a low-speed,side-impact automobile collision. She was discharged with analgesics after cervical spine radiographs showed no fracture and physical examination found no neurological deficits. She returned 18 days later with retrosternal pain and worsening neck pain, and cervical computed tomographic scan demonstrated an abnormal paratracheal air collection. Follow-up chest computed tomographic scan identified a right-sided tracheal diverticulum without evidence of pneumomediastinum.
气管旁气体积聚的鉴别诊断包括Zenker憩室、气管憩室、肺尖疝和纵隔气肿。在创伤情况下，纵隔气肿传统上被视为一个警示信号，需要对气管或食管破裂进行检查，这两种情况都具有很高的发病率。
一名患者在发生低速侧面碰撞的汽车事故数小时后因颈部疼痛就诊于急诊科。颈椎X线片显示无骨折，体格检查未发现神经功能缺损，给予镇痛药后出院。18天后，她因胸骨后疼痛和颈部疼痛加重再次就诊，颈椎计算机断层扫描显示气管旁有异常气体积聚。后续胸部计算机断层扫描发现右侧气管憩室，无纵隔气肿迹象。
