Cervicofacial Subcutaneous Emphysema in a Post-irradiated Nasopharyngeal Carcinoma Patient

頭頸部皮下氣腫於放射線治療後之鼻咽癌患者

蘇彥燁(Yan-Ye Su) ； 許睿芬(Ruey-Fen Hsu)

《台灣耳鼻喉頭頸外科雜誌》 44卷4期 (2009/08) Pp. 116-119

https://doi.org/10.6286/2009.44.4.116

摘要

頭頸部皮下氣腫，可能繼發於因肺泡破裂之縱隔腔氣腫、近期外傷或手術病史造成呼吸道或消化道破裂而導致，至於不明原因之自發性皮下氣腫則相當罕見。本院於2005年12月間經歷1名62歲男性病患，爲鼻咽癌放射治療後追踪15年之個案，就診時主訴爲右耳疼痛併右臉及頸部腫痛約5日，經問診除放射線治療後因鼻咽部不適，而有常年擤鼻習慣，並無近期外傷、異物食入及手術之病史。理學檢查發現右側外頸部皮下腫痛併捻髮音，但無一般深頸部感染之紅腫熱痛；經鼻咽喉內視鏡檢查無任何異常發現。電腦斷層掃描顯示不尋常氣體聚積，由右側顳骨下方至下頸部。食道攝影排除食道裂傷之臨床臆斷。血液學檢查顯示輕度白血球增生及C反應蛋白上升。病患住院3週接受預防性抗生素及保守治療，症狀獲得緩解改善，目前門診追蹤治療。此爲鼻咽癌病患發生自發性頭頸部皮下氣腫，爲一罕見病例，特此提出討論。

關鍵字

頭頸部皮下氣腫 ； 鼻咽癌

並列摘要

Cervicofacial subcutaneous emphysema often follows pneumomediastinum by way of air ascending along the mediastinum toward the subcutaneous space of the neck. We present a case of spontaneous cervicofacial subcutaneous emphysema with a past history of nasopharyngeal carcinoma (NPC) after radiotherapy. This impression based on no obvious etiology including dental procedure, trauma or surgical procedure recently, but the patient tended to frequently blow his nose for profuse crust in nasopharynx and nasal cavity after radiotherapy. We treated this patient conservatively with empiric antibiotics and maintained close observation. The symptoms got improved during one week of hospitalization, and totally resolved three weeks later. This is the first case of spontaneous cervicofacial subcutaneous emphysema in a post-irradiated NPC patient. We emphasized that thorough physical examination and image studies could help us make differential diagnosis and avoid unnecessary surgical intervention.

並列關鍵字

cervicofacial subcutaneous emphysema ； nasopharyngeal carcinoma