Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
Medicina (Kaunas). 2023 Feb 17;59(2):394. doi: 10.3390/medicina59020394.
Vomiting-induced pneumomediastinum is a rare presentation and can be a result of alveolar rupture (Mackler effect) or Boerhaave syndrome. Patients diagnosed with Boerhaave syndrome may present with the classic Mackler triad of vomiting, chest pain, and subcutaneous emphysema. However, there exists a large overlap of symptoms accompanying Boerhaave syndrome and the Macklin effect, including retrosternal chest pain, neck discomfort, cough, sore throat, dysphagia, dysphonia, and dyspnea. Boerhaave syndrome is a dangerous condition. Delayed diagnosis of Boerhaave syndrome may worsen sepsis and cause mortality. Therefore, early diagnosis and timely management are important to prevent further complications. Here, we present a case of vomiting-induced pneumomediastinum, which supports the use of bedside ultrasonography to aid in the diagnosis and rapid differentiation of etiology of pneumomediastinum.
呕吐导致的纵隔气肿较为罕见，其可能由肺泡破裂（Mackler 效应）或 Boerhaave 综合征引起。患有 Boerhaave 综合征的患者可能表现出经典的 Mackler 三联征，即呕吐、胸痛和皮下气肿。然而，Boerhaave 综合征和 Macklin 效应伴随的症状存在较大重叠，包括胸骨后疼痛、颈部不适、咳嗽、咽痛、吞咽困难、声音嘶哑和呼吸困难。Boerhaave 综合征是一种危险的情况。Boerhaave 综合征的延迟诊断可能会使脓毒症恶化并导致死亡。因此，早期诊断和及时治疗对于预防进一步的并发症非常重要。在这里，我们报告了一例呕吐导致的纵隔气肿病例，该病例支持使用床旁超声来辅助诊断和快速区分纵隔气肿的病因。
