自發性氣縱膈合併頸部皮下氣腫

固然胸痛或氣促是自發性氣縱膈最常見的主訴，但常常是症狀表現輕微或不典型，若擴展成頸部皮下氣腫時可能會出現頸部不適。一17歲男性，於劇烈運動時感到下頸部悶痛，基層診所臆斷為局部肌肉運動傷害，建議症狀治療。2小時後，卻因喉嚨痛至本院急診求診，頭頸胸之理學檢查並無異常發現，血液學檢查顯示白血球計數偏高，臆斷為急性上呼吸道感染或急性會厭炎。爾後，頸部攝片、胸部攝片及胸部電腦斷層檢查證實為氣縱膈合併頸部皮下氣腫，隨即收治住院接受2日之保守治療。因此，第一線基層醫師若遇到在劇烈運動後出現頸部不適之年輕男性，即使沒有胸痛或氣促，仍要想到此病的可能性。固然大部分患者的病程是良性且自限，預後良好，治癒後很少會有復發，但仍須注意是否源自於自發性食道破裂（Boerhaave氏症候群)，也必須注意是否併發呼吸道阻塞、氣胸、張力性氣縱膈或假性心包填塞。

關鍵字

馬克林效應；氣縱膈；縱膈腔氣腫；皮下氣腫；氣胸

並列摘要

Chest pain or dyspnea is a common complaint associated with spontaneous pneumomediastinum, but this presentation is often subtle or non-specific. Spontaneous pneumomediastinum presents as neck discomfort if associated with cervical subcutaneous emphysema. A 17-year-old male adolescent was bothered by lower cervical tightness and pain when exercising. A local myofascial sporting injury was impressed at the primary clinic. However, two hours later, a sore throat compelled him to visit our emergency room. A physical examination of the head, neck and chest did not show any abnormality. A blood examination showed leukocytosis. At this point an acute upper respiratory infection or acute epiglottitis was impressed. Follow up neck radiography, chest radiography and chest computed tomography demonstrated pneumomediastinum with cervical subcutaneous emphysema. He was admitted to hospital and treated conservatively over the following two days. Based on the above, a primary clinical physician should be aware of the possibility of spontaneous pneumomediastinum if they encounter a young man who has post-exercise cervical discomfort even in the absence of chest pain or dyspnea. Most spontaneous pneumomediastinum is benign and self-limited. The prognosis is good and recurrence is rare. However, the disease may involve spontaneous esophageal rupture (Boerhaave's syndrome) and may be complicated by airway obstruction, pneumothorax, tension pneumomediastinum or pseudo-cardiac tamponade.

並列關鍵字

Macklin effect ； pneumomediastinum ； mediastinal emphysema ； subcutaneous emphysema ； pneumothorax

國際替代計量

自發性氣縱膈合併頸部皮下氣腫

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