Medicine, Aga Khan University, Karachi, Pakistan
Medicine, Aga Khan University, Karachi, Pakistan.
BMJ Case Rep. 2021 Jul 30;14(7):e236549. doi: 10.1136/bcr-2020-236549.
A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum. CT neck and chest was done, which revealed subcutaneous emphysema and pneumomediastinum and a linear air density in close approximation to right posterolateral wall of trachea at the level of superior margin of sternum was reported. These findings raised the possibility of tracheal injury which was later confirmed by fiberoptic laryngoscopy. The patient was intubated due to hypercapnic respiratory failure resulting from hypoventilation and respiratory distress. Bilateral chest tube insertion was done due to worsening subcutaneous emphysema, high ventilator parameters and prevention of progression to pneumothorax. He was extubated after 5 days; bilateral chest tubes were removed before discharge and underwent uneventful recovery.
一名年轻男子在意外吸入氯气后出现呼吸急促和咳嗽，到急诊科就诊。最初的表现无明显异常；因此，他被观察了 8 小时，随后出院。5 小时后，患者再次因突发呼吸急促和胸部不适到急诊科就诊。检查发现颈部和胸部周围有皮下捻发音。胸部和颈部 X 光片显示皮下气肿和气胸。进行了颈部和胸部 CT 检查，结果显示皮下气肿和气胸，以及在胸骨上缘水平接近气管右后外侧壁的线性空气密度影。这些发现提示存在气管损伤的可能性，随后通过纤维喉镜检查得到证实。由于通气不足和呼吸窘迫导致高碳酸血症呼吸衰竭，患者需要插管。由于皮下气肿加重、呼吸机参数高以及预防气胸进展，双侧胸腔引流管插入。他在 5 天后拔管；双侧胸腔引流管在出院前拔除，患者恢复顺利。
