急性會厭炎併發兩側性膿胸－病例報告

急性會厭炎，易併發上呼吸道阻塞，乃眾所周知。但因急性會厭炎造成深頸部感染，進而向下擴展成兩側性膿胸，則為罕見。本部於1998年初經驗1名58歲女性病患，因急性會厭炎在他院治療達1星期未癒，復因漸進性呼吸困難而轉至本院。胸部X光可見兩側肋膜積水，給予引流後發現兩側均為膿性肋膜積液。雖經積極治療，病人最後仍因消化道出血而死亡。臨床上若遇到急性會厭炎經藥物治療無效，且呼吸困難加劇時，須考慮是否已合併深頸部或胸腔內感染，並照會相關科系，作緊急治療。

關鍵字

急性會厭炎；急性聲門上炎；縱隔炎；膿胸

並列摘要

Acute epiglottitis complicated by bilateral thoracic empyema is a rare condition which may lead to a grave outcome. The possible sequence of spread of infection is from the supraglottic structure, through the retropharyngeal lymph nodes, to the mediastinum and bilateral pleural cavities. We herein present a 58-year-old healthy woman who suffered from acute epiglottitis. Dyspnea appeared 10 days after the onset of sore throat. Decreased breath sounds were noted after admission and chest X-ray demonstrated bilat-eral pleural effusion. A chest tap revealed bilateral pleural effusion with foul greenish discharge. The bacteriology of the pleural effusion was the same as that of epiglottic pus, i.e. Proteus vulgaris and Klebsiella pneumoniae. The patient died one month later due to gastrointestinal bleeding despite intense open drainage and medical treatment. We conclude that acute epiglottitis can be complicated not only by upper airway obstruction but also by mediastinitis and thoracic empyema, which can be detected by chest ausculta-tion and X-ray examination, especially in patients with a prolonged course.

並列關鍵字

acute epiglottitis ； acute supraglottitis ； mediastinitis ； empyema

國際替代計量

急性會厭炎併發兩側性膿胸－病例報告

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