ENT, University Hospital Monklands, Airdrie, UK
ENT, University Hospital Monklands, Airdrie, UK.
BMJ Case Rep. 2021 Feb 1;14(2):e238700. doi: 10.1136/bcr-2020-238700.
A 15-year-old man presented with an acute history of facial swelling following a bout of forceful eructation after eating. Subcutaneous emphysema was noted on examination of his left face and neck. He was initially managed with intravenous antibiotics for suspected facial infection. A chest radiograph performed on day 3 of admission identified subcutaneous emphysema of the upper thorax and neck. CT with oral contrast confirmed extensive subcutaneous emphysema of neck, thorax and upper abdomen, with associated pneumomediastinum. The site of air leak was not identified. He subsequently underwent upper gastrointestinal endoscopy and this was normal. Despite the delay in diagnosis, he remained haemodynamically stable, and repeated radiography showed improvement reflecting the benign course of this condition as described in existing literature. There are no previous published reports of spontaneous pneumomediastinum following eructation; therefore, high clinical suspicion should be maintained in this presentation.
一位 15 岁男性，在剧烈呃逆后出现面部急性肿胀，左侧面部和颈部可触及皮下气肿。患者最初因疑似面部感染而接受静脉注射抗生素治疗。入院第 3 天行胸部 X 线检查发现上胸部和颈部皮下气肿。口服对比 CT 证实颈、胸和上腹部广泛皮下气肿，伴纵隔气肿。未确定漏气部位。随后行上消化道内镜检查未见异常。尽管诊断延迟，但患者血流动力学仍保持稳定，且重复影像学检查显示病情改善，反映了现有文献中描述的这种情况良性的病程。目前尚无呃逆后自发性纵隔气肿的既往报道；因此，对于这种表现，应保持高度的临床警惕。
