Öz
Travmatik pnömomediastinum (TPM) nadir görülen bir tablodur.
TPM baş, boyun, göğüs ve nadiren de ağız yaralanmaları sonucunda
oluşabilir. Kırk üç yaşında erkek hasta motorlu taşıt kazasından
yaklaşık 3 saat sonra göğüs ağrısı ve nefes darlığı ile Acil
servise getirildi. Yapılan muayenede yüzde, boyunda ve göğüste
yaygın bilateral cilt altı amfizemi ve krepitasyonu mevcuttu.
Elektrokardiyografisinde birinci derece AV blok görüldü. Yatarak
çekilen yatarak göğüs grafisi, yan boyun grafisi ve toraks tomografisinde
ciltaltı ve mediastende hava görüldü. Hasta hospitalize
edildikten sonra yapılan endoskopisi ve bronkoskopisi normal
olarak değerlendirildi. Hospitalizasyonunun 2. gününde mediatinal
amfizemin basınç etkisinde dolayı mediastinotomi yapıldı.
İlerleyen günlerde ortaya çıkan pnömothoraks ve mediastinal
amfizem tamamen iyileşti. Hasta 6. gününde sekelsiz olarak taburcu
edildi. Eğer trakea ve özefagus yaralanması önceden mevcut
ise TPM önemli bir durumdur.
Anahtar Kelimeler
Kaynakça
- Maravelli AJ, Skiendzielewski JJ, Snover W. Pneumomediastinum acquired by glass blowing. J Emerg Med 2000; 19: 145-7. [CrossRef]
- Caceres M, Braud RL, Maekawa R, Weiman DS, Garrett HE, Jr. Secondary pneumomediastinum: a retrospective comparative analysis. Lung 2009; 187: 341-6. [CrossRef]
- Lopez-Pelaez MF, 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: 306-9. [CrossRef]
- Emet M, Akoz A, Aslan S, Saritas A, Cakir Z, Acemoglu H. Assessment of cardiac injury in patients with blunt chest trauma. Eur J Trauma Emerg S 2010; 36: 441-7. [CrossRef]
- Chu CM, Leung YY, Hui JY, Hung IF, Chan VL, Leung WS, et al. Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome. The European respiratory journal: official journal of the European Society for Clinical Respiratory Physiology 2004; 23: 802-4.
- Demers G, Camp JL, Bennett D. Pneumomediastinum caused by isolated oral-facial trauma. Am J Emerg Med 2011; 29: 841.e3-8.
- Uscategui-Florez T, Martinez-Devesa P, Gupta D. Mucosal tear in the oropharynx leading to pneumopericardium and pneumomediastinum: an unusual complication of blunt trauma to the face and neck. The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 2006; 4: 179-82.
- Brearley WD, Jr., Taylor L, 3rd, Haley MW, Littmann L. Pneumomediastinum mimicking acute ST-segment elevation myocardial infarction. International Journal of Cardiology 2007; 117: e73-5. [CrossRef]
- Hamman L. Spontaneous interstitial emphysema of the lungs. Tr Assos Am Physicians 1937; 52: 311-9.
- Ralph-Edwards AC, Pearson FG. Atypical presentation of spontaneous pneumomediastinum. Ann Thorac Surg 1994; 58: 1758-60. [CrossRef]
Öz
Traumatic pneumomediastinum (TPM) is a rare entity. TPM may occur as a result of head, neck and thorax injury and rarely after oral injury. A 43-year-old man was brought to our ED approximately three hours after a motor vehicle accident (MVA) with complaints of angina pectoris and dyspnoea. His positive clinical findings were extensive bilateral subcutaneous emphysema and crepitation on his face, neck and trunk bilaterally. Electrocardiogram showed a first degree AV block. Supine chest x-ray, lateral neck x-ray and thorax CT showed subcutaneous and mediastinal air. After hospitalisation, bronchoscopy and endoscopy were performed with normal findings. On the second day, mediastinotomy was performed due to a pressure effect of the mediastinal emphysema. Complete resolution of the pneumothorax and mediastinal emphysema occurred gradually in the following days. He was discharged without any complication on the 6th day. TPM is an important issue if pre-existing trachea or oesophagus injury is present
Anahtar Kelimeler
Kaynakça
- Maravelli AJ, Skiendzielewski JJ, Snover W. Pneumomediastinum acquired by glass blowing. J Emerg Med 2000; 19: 145-7. [CrossRef]
- Caceres M, Braud RL, Maekawa R, Weiman DS, Garrett HE, Jr. Secondary pneumomediastinum: a retrospective comparative analysis. Lung 2009; 187: 341-6. [CrossRef]
- Lopez-Pelaez MF, 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: 306-9. [CrossRef]
- Emet M, Akoz A, Aslan S, Saritas A, Cakir Z, Acemoglu H. Assessment of cardiac injury in patients with blunt chest trauma. Eur J Trauma Emerg S 2010; 36: 441-7. [CrossRef]
- Chu CM, Leung YY, Hui JY, Hung IF, Chan VL, Leung WS, et al. Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome. The European respiratory journal: official journal of the European Society for Clinical Respiratory Physiology 2004; 23: 802-4.
- Demers G, Camp JL, Bennett D. Pneumomediastinum caused by isolated oral-facial trauma. Am J Emerg Med 2011; 29: 841.e3-8.
- Uscategui-Florez T, Martinez-Devesa P, Gupta D. Mucosal tear in the oropharynx leading to pneumopericardium and pneumomediastinum: an unusual complication of blunt trauma to the face and neck. The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 2006; 4: 179-82.
- Brearley WD, Jr., Taylor L, 3rd, Haley MW, Littmann L. Pneumomediastinum mimicking acute ST-segment elevation myocardial infarction. International Journal of Cardiology 2007; 117: e73-5. [CrossRef]
- Hamman L. Spontaneous interstitial emphysema of the lungs. Tr Assos Am Physicians 1937; 52: 311-9.
- Ralph-Edwards AC, Pearson FG. Atypical presentation of spontaneous pneumomediastinum. Ann Thorac Surg 1994; 58: 1758-60. [CrossRef]
Ayrıntılar
| Diğer ID | JA94CA52FV |
|---|---|
| Bölüm | Case Report |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Temmuz 2013 |
| Gönderilme Tarihi | 1 Temmuz 2013 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 4 Sayı: 3 |