自發性頸部皮下及縱膈氣腫

頭頸部與縱隔腔皮下氣腫可併發於多種疾病，原因是存在於呼吸消化道的氣體被動地進入皮下組織。依照不同的成因可以分爲自發性與非自發性，前者多數爲一良性的病程，鮮少造成循環系統的障礙而致死。一般接受保守性治療即可，甚少需要積極的手術介入。然而非自發性的成因例如頭頸部手術、氣管與食道創傷、口內創傷、呼吸消化道異物或腫瘤、以及使用呼吸器所造成的肺部傷害等，則需要進一步診治。本院於2006年3月經歷一名8歲男孩，於急診主訴當日喉嚨疼痛加遽伴隨呼吸急促、發燒、吞嚥疼痛、鼻塞、流鼻水等症狀，回顧此病人間斷性咳嗽已兩個月，局部理學檢查呈現咽部紅腫，實驗室檢查白血球略高，急診初步臆斷爲急性會厭炎。經側頸部X光顯示後咽部氣腫，遂行電腦斷層檢查，顯示廣泛性之頸部皮下氣腫，合併縱隔腔積氣，診斷爲急性自發性頸部皮下氣腫合併縱隔腔積氣。經住院接受抗生素與支持性治療3天，臨床症狀改善，影像追蹤顯示皮下氣腫明顯減少，順利出院。於回診時並無復發現象。因其臨床症狀有時會誤診爲單純上呼吸道感染，臨床醫師不可不提高警覺。本文將討論其臨床症狀、病態生理與醫療處置。

關鍵字

頸部皮下氣腫；縱隔腔積氣；咳嗽

並列摘要

Subcutaneous emphysema of the head, neck and mediastinum occurs with a variety of disease processes. Most cases involve the passive escape of air from the aerodigestive tract into subcutaneous tissues, such as: 1) during surgical procedures of head and neck, 2) after tracheal, esophageal and intraoral trauma, 3) in association with foreign bodies and neoplasms of the aerodigestive tract, 4) pulmonary barotrauma from mechanical ventilation, and 5) spontaneous episode. Spontaneous subcutaneous emphysema of head, neck and mediastinum typically follows a benign course and rarely results in circulatory collapse and death. The response to conservative therapy is generally good and aggressive surgical intervention is rarely required. We describe an 8-year-old boy who developed extensive subcutaneous emphysema extending from the base of skull and neck to the mediastinum following severe coughing caused by upper airway infection. Diagnostic and therapeutic recommendations are fully discussed.

並列關鍵字

cervical subcutaneous emphysema ； pneumomediastinum ； cough

國際替代計量

自發性頸部皮下及縱膈氣腫

全文下載

主題瀏覽