Frenkel Amit, Binyamin Yair, Zeldetz Vladimir, Koyfman Leonid, Klein Moti, Brotfain Evgeni
General Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
BMJ Case Rep. 2019 Feb 6;12(2):e227932. doi: 10.1136/bcr-2018-227932.
Pneumomediastinum (PNMD) entails the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema. PNMD may cause a wide variety of signs and symptoms, as well as ECG abnormality, including ST segment changes. We present a 56-year-old man admitted to our hospital after a trauma. After undergoing tracheostomy, he complained of chest discomfort. A chest X-ray in the posteroanterior view showed PNMD, and an ECG was suggestive of inferior-lateral wall myocardial infarction. An urgent cardiac catheterisation identified a critical obstruction at the origin of the right coronary artery. Following a balloon angioplasty, chest discomfort continued; and the ECG ST segments did not show any dynamic change during the subsequent 72 hours. We urge clinicians to perform a comprehensive workup for every patient presenting with PNMD and ST segment changes, to prevent unnecessary invasive procedures.
纵隔气肿（PNMD）是指纵隔内存在空气或其他气体，也被称为纵隔气肿。PNMD可能会引起各种各样的体征和症状，以及包括ST段改变在内的心电图异常。我们报告一名56岁男性，在经历创伤后入院。气管切开术后，他诉说胸部不适。后前位胸部X线片显示纵隔气肿，心电图提示下侧壁心肌梗死。紧急心脏导管检查发现右冠状动脉起始处严重阻塞。球囊血管成形术后，胸部不适仍持续存在；在随后的72小时内，心电图ST段未显示任何动态变化。我们敦促临床医生对每一位出现纵隔气肿和ST段改变的患者进行全面检查，以避免不必要的侵入性操作。
