Anjiyoödem Sanılan Pnömomediastinum: Olgu Sunumu

Abstract

Pnömomediastinum ve masif subkutan amfizem baş ve boyun ameliyatları, bronkoskopi ve trakeostomi gibi girişimler sırasında, toraks travması sonrasında, nadiren dental işlemler sırasında ve bazen de spontan olarak ortaya çıkabilen klinik durumlardır. Hastalar sıklıkla yüz, boyun ve bazen tüm vücutta şişlik, yutma güçlüğü, nefes darlığı, göğüs ağrısı ve ciltte krepitus gibi semptomlarla başvururlar. Bu bulgular genellikle aniden gelişir ve bazen saatler veya günler içinde ortaya çıkabilir. 48 yaşında erkek hasta bahçede düşmeye bağlı göğüs kafesinde ağrı şikâyeti ile hastaneye başvurur. Çekilen röntgen sonucunda herhangi bir patoloji olmadığı düşünülen hastaya ağrı kesici olarak ibuprofen reçete edilir ve taburcu edilir. İbuprofen aldıktan sonra anjiyoödem kliniği ile başvuran hastada pnömomediastinum olduğu tespit edilir. Vakada bahsedilen ve ilk etapta anjioödem düşünülen durumlarda dudakların şişmediğinin görülmesi ve cilt altı krepitasyonunun hissedilmesi, yani hastanın sadece inspeksiyon ve palpasyonla muayene edilmesi bile birkaç saniye içinde klinisyeni anjioödemden uzaklaştırıp doğru tanıya yönelmesini ve pnömomediastinum yönünde tetkikler yapmasını sağlar.

Keywords

• Acil Tıp
• Anjioödem
• Göğüs Cerrahisi
• Künt Travma
• Pnömomidastinum.

Pneumomediastinum Mistaken as Angioedema: Case Report

Abstract

Pneumomediastinum and massive subcutaneous emphysema are clinical conditions that can occur during head and neck surgeries, bronchoscopy and tracheostomy, after thoracic trauma, rarely during dental procedures and sometimes spontaneously. Patients often present with symptoms such as swelling of the face, neck and sometimes the whole body, difficulty swallowing, shortness of breath, chest pain and skin crepitus. These findings usually develop suddenly and sometimes may occur within hours or days. A 48-year-old man is applies to the hospital with complaint chest pain due to a fall in the garden. If no pathology is thought to be present as a result of the X-ray, the patient is prescribed ibuprofen for pain relief and discharged. Patient who presents with what appears to be angioedema after taking ibuprofen is found to have pneumomediastinum. In the cases mentioned in the report and initially thought to be angioedema, seeing that the lips are not swollen and feeling subcutaneous crepitation, i.e. even just inspecting and palpating the patient, will distract the clinician from angioedema in a few seconds and direct him/her to the correct diagnosis and perform examinations in the direction of pneumomediastinum.

Keywords

• Angioedema
• Blunt Trauma
• Emergency Medicine
• Pneumomediastinum
• Thoracic Surgery.

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