Ein S H, Shandling B, Humphreys R, Krajbich I
Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Surg. 1988 Aug;23(8):779-81. doi: 10.1016/s0022-3468(88)80427-5.
A healthy 3-week-old baby girl developed a cyanotic spell that required intubation and ventilation. During part of her initial emergency examination and treatment, a neck mass was felt, and a positive blood culture grew staphylococcus aureus. She was transferred to the ICU, and was ventilated and treated with intravenous cloxacillin. Bronchoscopy showed a paralyzed left cord. Computerized tomography (CT) scan of her neck showed a midline mediastinal mass (behind the compressed trachea and esophagus), that extended from C7 to the carina. Because of the suspicion of an abnormal C7 vertebral body, diagnosis of a neurenteric cyst was made, and a myelogram showed a complete block at the T1 level and an absent C7 vertebral body. There were no neurologic signs. Her right knee then became red and swollen, and x-rays showed a lytic area in the distal femur. This knee was explored under general anesthesia, and an osteomyelitis found and drained. Several days later, a barium swallow showed the mediastinal mass pushing the esophagus to the left, but several more cervical vertebrae were "missing," and the diagnosis of osteomyelitis of the cervical spine was confirmed. The mediastinal staphylococcal abscess was then drained through the neck. Follow-up has been unremarkable over the last 4 years.
一名健康的3周大女婴出现了青紫发作，需要插管和通气。在其最初的急诊检查和治疗过程中，摸到了颈部肿块，血培养结果显示金黄色葡萄球菌呈阳性。她被转入重症监护病房，接受了通气治疗，并静脉注射氯唑西林。支气管镜检查显示左侧声带麻痹。颈部计算机断层扫描（CT）显示纵隔中线有一个肿块（位于受压的气管和食管后方），从C7延伸至隆突。由于怀疑C7椎体异常，诊断为神经肠囊肿，脊髓造影显示T1水平完全阻塞，C7椎体缺失。没有神经症状。随后她的右膝出现红肿，X线显示股骨远端有一个溶骨区。在全身麻醉下对该膝关节进行探查，发现并引流了骨髓炎。几天后，吞钡检查显示纵隔肿块将食管推向左侧，但又有几节颈椎“缺失”，颈椎骨髓炎的诊断得到证实。然后通过颈部引流纵隔葡萄球菌脓肿。在过去4年的随访中情况良好。
