Maunder R J, Pierson D J, Hudson L D
Arch Intern Med. 1984 Jul;144(7):1447-53.
Subcutaneous emphysema and pneumomediastinum occur frequently in critically ill patients in association with blunt or penetrating trauma, soft-tissue infections, or any condition that creates a gradient between intra-alveolar and perivascular interstitial pressures. A continuum of fascial planes connects cervical soft tissues with the medlastinum and retroperitoneum, permitting aberrant air arising in any one of these areas to spread elsewhere. Diagnosis is made in the appropriate clinical setting by careful physical examination and inspection of the chest roentgenogram. While the presence of air in subcutaneous or mediastinal tissue is not dangerous in itself, prompt recognition of the underlying cause is essential. Certain trauma-related causes may require surgical intervention, but the routine use of chest tubes tracheostomy, or mediastinal drains is not recommended.
皮下气肿和纵隔气肿在重症患者中经常出现，与钝性或穿透性创伤、软组织感染或任何导致肺泡内和血管周围间质压力梯度的情况有关。连续的筋膜平面将颈部软组织与纵隔和腹膜后间隙相连，使得这些区域中任何一处出现的异常气体能够扩散到其他部位。通过仔细的体格检查和胸部X线检查，在适当的临床环境中做出诊断。虽然皮下或纵隔组织中存在气体本身并不危险，但迅速识别潜在病因至关重要。某些与创伤相关的病因可能需要手术干预，但不建议常规使用胸管、气管切开术或纵隔引流。
