BOYUN VE YÜZ BÖLGESİNE UYGULANAN MİNÖR TRAVMA SONUCU OLUŞAN POST-TRAVMATİK PNÖMOMEDİASTİNUM OLGUSU

Öz

Pnömomediastinum; mediasten içerisinde hava bulunması olarak tanımlanır ve spontan, iatrojenik, travmatik olarak 3 gruba ayrılır. Olgumuz; başından, yüzünden ve boynundan künt travmaya maruz kalmış 22 yaşında bir kadındır. Yapılan fizik muayeneleri, kan testleri ve bilgisayarlı tomografileri taramaları sonucunda; özefagus etrafında ve ön mediastende minimal multiple hava imajları (pnömomediastinum) görülmüştür. Pnömo/hemotoraks ya da kosta fraktürü izlenmemiştir. Klinikte oksijen inhalasyon tedavisi ve 24 saatlik grafileri ile takip ve diğer tedavileri yapılmıştır. Olgu, adli tıbbi açıdan “kişinin yaşamını tehlikeye sokan bir durum olması” ve başkaca eşlik eden bir patoloji olmadan pnömomediastinumun az rastlanan bir durum olması nedeniyle literatür ile karşılaştırılarak tartışılmıştır.

Anahtar Kelimeler

• Pnömomediastinum
• Adli travmatoloji
• Künt travma

Kaynakça

1. Weissberg D, Weissberg D. Spontaneous mediastinal emphysema. Eur J Cardiothorac Surg. 2004;26(5):885-8.
2. Brenner WG, Kumar CM. Delayed surgical emphysema, pneumomediastinum and bilateral pneumothoraces after postoperative vomiting. Br J Anaesth 1993;71:296–7
3. Gunluoglu MZ, Cansever L, Demir A, Kocaturk C, Melek H, Dincer SI, Bedirhan MA. Diagnosis and treatment of spontaneous pneumomediastinum. Thorac Cardiovasc Surg. 2009;57(4):229-31
4. Yellin A, Gapany-Gapanavicius M, Lieberman Y. Spontaneous pneumomediastinum: is it a rare cause of chest pain? Thorax 1983;38:383-385
5. Jougon JB, Ballester M, Delcambre F, et al. (2003) Assessment of spontaneous pneumomediastinum: experience with 12 patients. Ann Thorac Surg 75:1711–4
6. Lopez-Pelaez M.F, Roldan J, Mateo S. Cervical Emphysema, Pneumomediastinum, and Pneumothorax Following Self-induced Oral Injury: Report of Four Cases and Review of the Literature. Chest 2001;120(1);306-9
7. Hafberg E, Gudmundsson G, Gudbjartsson T. Spontanous pneumomediastinum after yoga practice - a case report. Laeknabladid. 2009;95(4):279-81.
8. Kashyap AS, Anand KP, Kashyap S. Complications of yoga. Emerg Med J. 2007;24(3):231.

9. Cecchetto G, Viel G, Cecchetto A, Kusstatscher S, Montisci M. Fatal Splenic Rupture Following Heimlich Maneuver Case Report and Literature Review Am J Forensic Med Pathol 2011;32(2):169-1
10. Chun BJ, Moon JM. Symptomatic Epidural Pneumorrhachis Associated With an Occult Pneumomediastinum Due to Minor Trauma.Spine(Phila pa 1976). 200915;34(26):979-82
11. Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE. Spontaneous Pneumomediastinum: A Comparative Study and Review of the Literature Ann Thorac Surg 2008;86(3):962-6
12. Palmese S, Carbone D, Muoio R, Scarano D, Odierna I, Scibilia AC, Natale A. The Macklin effect in the etiology for pneumediastinum in chest trauma. 2008;99(9):458-60.
13. Bilkis M.D, Monteverde E. Efecto Macklin en el neumomediastino espontaneo pediatrico. Arch Argent Pediatr 2010;108(2);33-6
14. Mondello B, Pavia R, RuggeriP, Barone M, Barresi P, Monaco M. Spontaneous Pneumomediastinum: Experience in 18 Adult Patients. Lung (2007) 185(1):9–14
15. Oliaro A, Filosso PL, Casadio C, Cianci R, Rastelli M, Leo F, Porrello C, Maggi G. Spontaneous and traumatic pneumomediastinum. Analysis of 34 cases. 1997;52(7- 8):913-7
16. Rezende-Neto J.B, Hoffmann J, Al Mahroos M,Tien H, Hsee LC, Netto FC. Speers V, Rizoli SB. Occult pneumomediastinum in blunt chest trauma: Clinical significance Injury 2010;41(1) 40-3
17. Heijl M, Saltzherr TP, Berge Henegouwen MI, Goslings JC. Unique case of esophageal rupture after a fall from height. BMC Emergency Medicine 2009;15(1):9-24
18. Smock E.D, Andrew A. A case of traumatic rupture of the distal oesophagus: the importance of early diagnosis. European Journal of Emergency Medicine 2008;15(2):95-6
19. Eipe N, Choudhrie A, Tracheal rupture in a child with blunt chest injury. Pediatric Anesthesia 2007;17(3):273-77
20. Pearsall LA, Metz MA, Watson TJ, Gestring ML. Membranous Tracheal Injury After Blunt Thoracic Trauma. J Trauma. 2005;59(6):1533-4.
21. Gibikote S, Wray A, Fink AM. Pneumorrhachis secondary to traumatic pneumomediastinum in a child. Pediatr Radiol 2006;36(7):711-3
22. Brian K, Allen W. Traumatic Pneumorrhachis J Trauma. 2005;58(4):875-9
23. Markarian MK, MacIntyre D.A, Cousins BJ, Fildes JJ, Malone A. Adolescent pneumopericardium and pneumomediastinum after motor vehicle crash and ejection. Am J Emerg Med 2008;26(4):515
24. Buterbaugh J.E., Erly W.K. Paratracheal Air Cysts: A Common Finding on Routine CT Examinations of the Cervical Spine and Neck That May Mimic Pneumomediastinum in Patients With Traumatic Injuries. AJNR Am J Neuroradiol 2008;29(6):1218-21
25. MondelloB, Rosaria PaviaR, Ruggeri P, Barone M, Barresi P, Monaco M. Spontaneous Pneumomediastinum: Experience in 18 Adult Patients Lung 2007; 185(1):9–14
26. Pustahija AH, Markovic MV, Ivanac G,Franceski D, Brkljacic B. An unusual case of bronchial rupture pneumomediastinum appearing 7 days after blunt chest trauma. Emerg Radiol 2009;16(2):163-5
27. MacLeod JB, Tibbs BM, Freiberger DJ, Rozycki GS, Lewis F, Feliciano DV. Pneumomediastinum in the injured patient: inconsequential or predictive? Am Surg. 2009;75(5):375-7.
28. Dissanaike S, Shalhub S, Jurkovich GJ. The evaluation of pneumomediastinum in blunt trauma patients. J Trauma 2008;65(6):1340-5.
29. Neal M.D, Sippey M, Gaines B.A, Hackam D.J. Presence of pneumomediastinum after blunt trauma in children: what does it really mean? Journal of Pediatric Surgery 2009; 44(7):1322-7
30. Cianchetti JA, Carroll GF. Traumatic pneumomediastinum resulting from facial trauma 1980;9(4):218-21
31. Pryor SD, Lee LK. Clinical Outcomes and Diagnostic Imaging of Pediatric Patients With Pneumomediastinum Secondary to Blunt Trauma to the Chest. J Trauma. 2011 Oct;71(4):904-8