Rey C, Alvin P, Pariente D, Courtecuisse V
Service de médecine pour adolescents, hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Arch Pediatr. 1994 Jul;1(7):652-4.
Pneumomediastinum is a rare complication of anorexia nervosa. It may occur in patients with severe weight loss and a history of induced vomiting.
A 14 year-old girl was admitted suffering from severe anorexia nervosa. Shortly after admission, she complained of anterior thoracic pain. Examination showed subcutaneous emphysema of the supraclavicular fossae and the base of the neck. Thoracic X-ray showed pneumomediastinum without pneumothorax. At the time, the patient admitted to a history of surreptitious chronic induced vomiting. Gastrografin esophagography ruled out an oesophageal tear. The pneumomediastinum gradually disappeared over a period of several days with simple clinical and radiological monitoring.
This case, along with seven others reported in the literature, confirms that pneumomediastinum in anorexia nervosa is usually not accompanied by pneumothorax. An oesophageal perforation must always be ruled out. Spontaneous pneumomediastinum invariably has a favorable outcome.
纵隔气肿是神经性厌食症的一种罕见并发症。它可能发生在体重严重减轻且有诱发性呕吐史的患者身上。
一名14岁女孩因严重神经性厌食症入院。入院后不久，她诉说胸前区疼痛。检查发现锁骨上窝和颈部底部有皮下气肿。胸部X线显示纵隔气肿，无气胸。当时，患者承认有偷偷进行慢性诱发性呕吐的病史。泛影葡胺食管造影排除了食管撕裂。通过简单的临床和放射学监测，纵隔气肿在几天内逐渐消失。
本病例以及文献中报道的其他7例病例证实，神经性厌食症中的纵隔气肿通常不伴有气胸。必须始终排除食管穿孔。自发性纵隔气肿的预后总是良好的。
