Ojha Shilpa, Gaskin Julian
ENT, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
BMJ Case Rep. 2018 Feb 11;2018:bcr-2017-222965. doi: 10.1136/bcr-2017-222965.
Spontaneous pneumomediastinum is the presence of free air within the mediastinum that is not associated with trauma. It is a rare, self-limiting condition that can cause widespread subcutaneous surgical emphysema. We present the case of a 12-year-old boy who presented with widespread spontaneous surgical emphysema and pneumomediastinum, with no history of trauma or respiratory tract disease. We discuss our assessment of him and management with our multidisciplinary team (MDT), and whether radiological investigations including CT are helpful in such cases. In conclusion, we hypothesised that the child's coughing was the most likely cause of the tracheal rupture leading to the spontaneous surgical emphysema. Spontaneous pneumomediastinum in the paediatric patient is extremely rare. This case highlights how spontaneous pneumomediastinum can be successfully managed conservatively, and how MDT input can be helpful in guiding management in such unusual cases.
自发性纵隔气肿是指纵隔内存在游离气体且与外伤无关。它是一种罕见的自限性疾病，可导致广泛的皮下手术性气肿。我们报告一例12岁男孩，表现为广泛的自发性手术性气肿和纵隔气肿，无外伤或呼吸道疾病史。我们讨论了对他的评估以及与多学科团队（MDT）的管理，以及包括CT在内的放射学检查在此类病例中是否有帮助。总之，我们推测孩子的咳嗽是导致气管破裂进而引起自发性手术性气肿的最可能原因。小儿患者的自发性纵隔气肿极为罕见。本病例突出了自发性纵隔气肿如何能够通过保守治疗成功处理，以及多学科团队的参与在指导此类罕见病例的管理中如何发挥作用。
