Kiryu T, Kobayashi H, Kawaguchi S, Kanou S, Uwabe Y, Sakai M, Matsuoka T, Nagata N
Third Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1993 Jun;31(6):771-4.
A 46-year-old woman was admitted to our hospital for a severe asthma attack. On admission, systemic cyanosis was observed, and her consciousness state was drowsy. Arterial blood gas showed severe respiratory acidosis, hypoxia, and hypercapnea, with pH, PaO2, and PaCO2 of 7.163, 29.9 torr and 81.3 torr, respectively. Immediately, mechanical ventilation was commerced but on the third hospital day pneumomediastinum and subcutaneous emphysema appeared, and on the sixth day pneumoperitoneum also appeared. The chest CT scan on the sixth day showed free air around bilateral internal mammary vessels. This indicated that air moved from the mediastinum into the peritoneal cavity through an anterior route, via the sternocostal triangle formed by the xiphoid origins of the diaphragm medially and the costal origins laterally.
一名46岁女性因严重哮喘发作入院。入院时,观察到全身发绀,意识状态嗜睡。动脉血气显示严重呼吸性酸中毒、低氧血症和高碳酸血症,pH值、动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)分别为7.163、29.9托和81.3托。立即开始机械通气,但在住院第三天出现纵隔气肿和皮下气肿,第六天还出现了气腹。第六天的胸部CT扫描显示双侧胸廓内血管周围有游离气体。这表明气体通过由内侧膈肌剑突起始部和外侧肋起源形成的胸骨肋三角从前路从纵隔进入腹腔。