Hacettepe University, School of Medicine, Department of Emergency, Turkey.
Hacettepe University, School of Medicine, Department of Emergency, Turkey.
Am J Emerg Med. 2018 Nov;36(11):2133.e1-2133.e3. doi: 10.1016/j.ajem.2018.08.027. Epub 2018 Aug 8.
Tracheal rupture is mostly traumatic or iatrogenic. A few cases of spontaneous tracheal rupture have been reported in literatüre and all of them have been described posterior membraneous wall which is the weakest portion of trachea. In most of such cases, predisposing factors that weaken the tracheal structure were present. We presented the first case of spontaneous anterolateral tracheal rupture as a result of coughing that caused no respiratory distress and that spontaneously recovered without any complications. A 24 year old male presented to the emergency department with sore throat. After eating chicken shawarma, the patient felt a lump in his throat and coughed. After coughing, a tearing like and severe pain developed at his neck's front region radiating to his shoulders and back. On past medical history, the patient had no known diseases and had no history of use of medications. Physical examination findings were unremarkable except for neck tenderness. Pneumomediastinum, free air within the cervical fascias and a 4mm tracheal mural defect on the left anterolateral side at the level superior to the manubrium was observed in computerised tomography scan of neck and chest. The patient had no shortness of breath and therefore urgent surgery was not considered. Increase in free air was not seen in the control x-rays 6 hours later. The patient with a foriegn nationality left the emergency at his own will. He was contacted one month later via telephone. The patient said that his neck pain subsided and had no other complaints.
气管破裂主要是外伤性或医源性的。文献中有少数自发性气管破裂的病例报道，所有这些病例均发生在气管后膜壁，这是气管最薄弱的部位。在大多数情况下，存在使气管结构变弱的诱发因素。我们报告了首例因咳嗽引起的自发性前外侧气管破裂的病例，咳嗽没有引起呼吸困难，并且自行恢复，没有任何并发症。一名 24 岁男性因咽痛就诊于急诊科。在吃了鸡肉沙威玛后，患者感到喉咙有异物感并咳嗽。咳嗽后，颈部前区出现撕裂样剧痛，并放射至肩部和背部。在既往病史中，患者无已知疾病，无用药史。除颈部触痛外，体格检查未见异常。颈部和胸部计算机断层扫描显示纵隔气肿，颈部筋膜内游离空气，以及胸骨柄上方水平的左侧前外侧气管壁 4mm 的壁缺损。患者无呼吸困难，因此未考虑紧急手术。6 小时后的对照 X 光片未见游离空气增加。这名外国患者自行离开急诊。一个月后通过电话联系了他。患者表示颈部疼痛减轻，无其他不适。
