Gregory M W, Jacobsen W M
Department of Surgery, Maricopa Medical Center, Phoenix, Arizona 85008, USA.
J Trauma. 1996 Nov;41(5):899-901. doi: 10.1097/00005373-199611000-00025.
Posttraumatic bacterial mediastinal abscess resulting from closed blunt trauma without penetrating injury or tracheal or esophageal rupture is, to our knowledge, previously unreported. We report a case of a patient injured in a motor vehicle collision that resulted in closed blunt chest trauma and mediastinal abscess 14 days after injury. Initial chest roentgenogram revealed a widened mediastinum. Computed tomographic scan of the chest revealed comminuted fractures of the upper sternum, manubrium, and the 3rd and 4th left anteriolateral ribs and a retrosternal hematoma. Transesophageal echocardiography was negative. The patient was dismissed 2 days after injury and returned to the hospital 14 days after injury with a fluctuant, pulsatile, upper midline chest wall and anteriolateral chest wall staphylococcal abscesses. The abscesses were drained and the sternomanubrial wound debrided in stages. The mediastinal defect was reconstructed with a pectoralis major muscle flap. This most likely represents bacterial seeding of the mediastinal hematoma from a distant source.
据我们所知，因闭合性钝性创伤而非穿透性损伤或气管或食管破裂导致的创伤后细菌性纵隔脓肿此前未见报道。我们报告一例患者，该患者在机动车碰撞中受伤，导致闭合性钝性胸部创伤，并在受伤14天后出现纵隔脓肿。最初的胸部X线片显示纵隔增宽。胸部计算机断层扫描显示胸骨上段、胸骨柄以及左前外侧第3和第4肋骨粉碎性骨折，胸骨后血肿。经食管超声心动图检查结果为阴性。患者受伤后2天出院，受伤14天后返回医院，出现波动性、搏动性的胸骨上中线上部胸壁和前外侧胸壁葡萄球菌脓肿。脓肿被引流，胸骨柄伤口分期清创。用胸大肌瓣重建纵隔缺损。这很可能代表纵隔血肿由远处来源的细菌播散所致。
