第194课病例探析（042）-纵隔气肿

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上期试题：艾滋病患者肺部感染最多见的病原体是 B

A．新型隐球菌

B．肺孢子菌

C．结核分枝杆菌

D．白假丝酵母菌

E．巨细胞病毒

男，42岁，突发气喘、胸痛。

病人可感到突然的胸骨后疼痛、闷胀，放射到两肩和两臂。疼痛随呼吸或吞咽动作而加重。纵隔积气如较严重，可压迫静脉阻碍回流。纵隔内气体可进入颈部和胸壁，出现皮下气肿。

The patient can feel the sudden pain and swelling in the sternum, radiating to the shoulders and arms. Pain increases with breathing or swallowing. The mediastinum is more severe, and the compression of the venous obstruction is impeded. Mediastinal gas can enter the neck and chest wall, subcutaneous emphysema.

纵膈气肿形成病因

Mediastinal emphysema is a cause of disease.

①肺泡破裂空气沿肺血管周围鞘膜进入纵隔，常有吸气后屏气，用力剧咳等诱因，见于支气管哮喘、细支气管炎、百日咳等疾病。肺泡破裂引起自发性气胸亦可发生纵隔气肿。

The pulmonary alveolar rupture air enters the mediastinum along the perivascular sheath of the pulmonary vessels, often with inhalation of the breath, and the causes of cough, such as bronchial asthma, bronchiolitis, pertussis and other diseases. Spontaneous pneumothorax can also occur in spontaneous pneumothorax.

②在治疗呼吸窘迫征时，应用呼气末正压呼吸，所用的压力过高易引起肺脏气压伤，发生自发性气胸和（或）纵隔气肿。

In the treatment of respiratory distress, the application of the expiratory pressure and pressure is too high to cause air pressure, spontaneous pneumothorax and/or mediastinal emphysema.

③胸部外伤、内窥镜检查或吸入异物等，可引起支气管或食管破裂而发生纵隔气肿。食管痉挛阻塞，常在食管下部200px处发生纵行撕裂，因该处食管无结缔组织支持。食管破裂常伴发胸腔积液或脓胸。

In the case of chest trauma, endoscopic examination, or inhalation of foreign body, it can cause the bronchial or esophageal rupture to occur. Esophageal spasm occlusion, often in the lower esophagus of the esophagus in the esophagus, a longitudinal row of tears, because of the esophageal connective tissue support. Esophageal rupture is often accompanied by pleural effusion or pus.

④颈部手术，如甲状腺切除术或扁桃体切除术，有时气体可沿颈深筋膜间隙进入纵隔。气管切开术，若皮肤切口过小，气管切口过大，空气逸出易发生纵隔气肿。

For cervical surgery, such as thyroidectomy or tonsillectomy, sometimes the gas can enter the mediastinum along the deep cervical fascia. Tracheotomy, if the skin incision is too small, the tracheal incision is too large, air escape is easy to occur mediastinal emphysema.

⑤胃肠穿孔、肾周围充气造影术或人工气腹术，腹腔内气体可经膈肌主动脉裂孔和食管裂孔周围的疏松组织进入纵隔。

The gas in the abdominal cavity can be medially separated from the loose tissue around the aortic cleft of the diaphragm and the esophageal hiatus.

⑥以自发性纵隔气肿最常见，大多继发于间质性肺气肿。

It is most common in spontaneous mediastinal emphysema, mostly secondary to interstitial emphysema.

影像特点

1.纵隔两侧边缘可见与其平行的线条阴影，该线条影内侧见有透亮的气体阴影，上纵隔更明显，可见颈部皮下气肿。

1. The line shadows on both sides of the mediastinum can be seen with parallel lines. The inner part of the line is visible with a bright gas shadow, and the upper mediastinum is more obvious, and the subcutaneous emphysema of the neck can be seen.

2.侧位胸片见胸骨后有一增宽的透亮区，将纵膈胸膜推移向后呈线条状阴影，升主动脉前缘轮廓特别清楚。

2. The lateral thoracic film shows a widened and brightening area behind the sternum, and the mediastinal pleura is presented with a line shadow backward, and the contour of the ascending aorta is particularly clear.

3.在婴儿，纵隔内大量气体可使胸腺显示并向上移。

3. In a baby, a large amount of gas in the mediastinum can show the thymus and move up.

4.纵隔气肿向下扩散至心脏与膈之间，使两侧横膈与纵隔呈连续状充气，称为“隔连续征”。

4. The mediastinal emphysema diffuses down to the heart and the diaphragm, causing the diaphragmatic and mediastinum to be continuously inflated, which is known as the 'continuous sign'.

5.左膈上及食管旁气体阴影，是食管损伤或自发性破裂较为特征性的表现。

5. The left diaphragmatic and esophageal gas shadows are characteristic manifestations of esophageal injury or spontaneous rupture.

6.CT和 MRI可以显示少量气肿，比胸部平片更准确可靠。纵隔边缘处有带状含气区，其中无肺纹理显示。

6.CT and MRI can show a small amount of emphysema, which is more accurate and reliable than the chest plate. There is a zonal gas zone at the edge of the mediastinum, which shows no lung texture.

本期试题：自发性气胸行闭式引流时排气过快，最易引起的并发症是？

A．皮下气肿

B．脓胸

C．伤口不愈合

D．纵隔气肿

E．复张后肺水肿

影像常见征象