Hashimoto T, Ishizawa Y, Yamamoto T, Shimonaka H, Dohi S
Department of Anesthesiology, Gifu University School of Medicine.
Masui. 1995 Mar 3;44(3):434-7.
A 52-yr-old man with esophageal cancer underwent esophagectomy and retrosternal reconstruction using stomach under general anesthesia. In the postoperative period, the patient developed mediastinal abscess which failed to be diagnosed by daily routine chest X-rays, because of surgical alterations of mediastinal anatomy. On the 11th postoperative day, the abscess ruptured into the trachea and severe hypoxemia (PaO2 73 mmHg, FIO2 1.0) developed while the patient was still on mechanical ventilation. A chest X-ray on that day showed a radiolucent cavity with defined margins in the right superior mediastinum. Thoracic CT scanning on the 15th postoperative day disclosed a capsulated cavity which indicated abscess formation in the posterior mediastinum. Although surgical drainage was not undertaken, the patient's severe hypoxemia was resolved within 4 days by the supportive therapies including chest physiotherapy, postural drainage and administration of antibiotics and corticosteroids. Although mediastinal abscess after esophagectomy is a rare complication, it may rupture into the trachea and lead to severe hypoxemia. In this case thoracic CT scanning was useful to detect the mediastinal abscess which had not been diagnosed by routine chest X-rays.
一名52岁的食管癌男性患者在全身麻醉下接受了食管切除术，并采用胃进行胸骨后重建。术后，患者出现纵隔脓肿，由于纵隔解剖结构的手术改变，每日常规胸部X线检查未能诊断出该脓肿。术后第11天，脓肿破入气管，患者仍在机械通气时出现严重低氧血症（动脉血氧分压73 mmHg，吸入氧分数1.0）。当日胸部X线显示右上纵隔有一个边缘清晰的透亮腔。术后第15天的胸部CT扫描显示一个有包膜的腔，提示后纵隔脓肿形成。尽管未进行手术引流，但通过胸部物理治疗、体位引流以及使用抗生素和皮质类固醇等支持治疗，患者的严重低氧血症在4天内得到缓解。虽然食管切除术后纵隔脓肿是一种罕见的并发症，但它可能破入气管并导致严重低氧血症。在该病例中，胸部CT扫描有助于检测出常规胸部X线未诊断出的纵隔脓肿。
