Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
Indian J Tuberc. 2020 Oct;67(4):567-570. doi: 10.1016/j.ijtb.2020.07.015. Epub 2020 Jul 19.
Spontaneous Pneumomediastinum (SPM) is a benign, self-limiting but potentially fatal condition specially in underlying pulmonary disease. Spontaneous pneumomediastinum is rarely associated with connective tissue related interstitial lung disease. We report a patient of interstitial pneumonia with autoimmune features who presented with acute onset breathlessness and was diagnosed to have spontaneous pneumomediastinum, pneumopericardium, and subcutaneous emphysema. This condition are easily diagnosed by clinical findings like Hamman's crunch and plain chest radiographs in cases with normal underlying lungs. In cases of extensive pulmonary fibrosis like Interstitial Lung Diseases both clinical findings and Plain chest radiographs can be inconclusive. CT of thorax is the gold standard diagnostic modality. Pneumopericardium rarely leads to cardiac tamponade, which requires immediate surgical intervention. We conclude that every case of acute onset breathlessness in a known case of interstitial lung disease may not necessarily be an exacerbation of the underlying lung condition. Physicians need to have a high index of suspicion while treating patients of interstitial lung disease. CT thorax is gold standard diagnostic modality especially in presence of fibrotic lung diseases.
自发性纵隔气肿（SPM）是一种良性、自限性但潜在致命的疾病，特别是在基础肺部疾病的情况下。自发性纵隔气肿很少与结缔组织相关的间质性肺疾病相关。我们报告了一例伴有自身免疫特征的间质性肺炎患者，其表现为急性发作性呼吸困难，并被诊断为自发性纵隔气肿、心包积气和皮下气肿。在正常基础肺部的情况下，这种情况很容易通过临床发现，如汉曼氏嘎吱声和普通胸部 X 射线来诊断。在广泛的肺纤维化（如间质性肺病）的情况下，临床发现和普通胸部 X 射线都可能不明确。胸部 CT 是金标准诊断方式。心包积气很少导致心脏压塞，需要立即手术干预。我们的结论是，在已知的间质性肺疾病患者中，急性发作性呼吸困难的每一例情况不一定都是基础肺部状况的恶化。在治疗间质性肺疾病患者时，医生需要高度怀疑。胸部 CT 是金标准诊断方式，特别是在存在纤维化性肺部疾病的情况下。
