纵隔气肿、ST段抬高与紧急心脏导管插入术：关键三联征？
Pneumomediastinum, ST elevation and urgent cardiac catheterisation: a crucial triad?
作者信息
Frenkel Amit, Binyamin Yair, Zeldetz Vladimir, Koyfman Leonid, Klein Moti, Brotfain Evgeni
机构信息
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.
出版信息
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。
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