安博 發問時間: 社會與文化語言 · 5 年前

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The incidence of SPM is relatively rare,with one study reporting only 1 case in 44,511 admissions to the emergency department(2). Another report indicated that the incidence of SPM in children was 1:11,726 at an emergency department in central Taiwan(3). However, the true incidence of SPM is unknown because the clinical and radiological presentation may be subtl.The common clinical presentation of SPM involves chest pain (89%), dyspnea (67%),dysphagia (18%), and neck pain (11%)(4). Pneumothorax was not observed in our patient. A retrospective review of 62 patients with SPM identified concomitant pneumothorax in 32% of patients. There may have been a high rate of pneumothorax in that study because of the high prevalence of preexisting lung disease and the advanced age of the patients(5)

In this present case, the clinical picture revealed subcutaneous emphysema in the neck and chest wall with crepitus. In one report, the diagnosis of SPM was made by chest radiography alone(6). In another report, 70% of 33 cases of SPM were identified by chest radiograpy and the remaining 30% were discovered by chest CT scan(7).Computed tomography scan of the chest can help establish the diagnosis when chest radiography is ambiguous for identification of SPM.In a previous review, one of 18 patients with SPM experienced complications and received surgical intervention(4). Jogging-induced pneumomediastinum should be differentiated from other life-threatening conditions such as esophageal rupture or bronchial perforation. It is important to differentiate between SPM and secondary pneumomediastinum, such as Boerhaave syndrome. Secondary pneumomediastinum is associated with traumatic chest injury or intrathoracic disease, and there may be a high incidience of pneumothorax and a poor outcome if not diagnosed immediately. In our patient, SPM and subcutaneous emphysema were rare sequelare after jogging. The possible pathophysiology in this present case may be the development of increased

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In the initial management of this patient, a decision had to be made between emergency diagnostic tests and conservative therapy. Yellin et al. reported that for a healthy patient with free air in the mediastinum but no pneumothorax, conservative treatment and observation are adequate, and invasive

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  • 5 年前
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    SPM的發病率是比較少見的,有一項研究報告僅1例在44511接診的急診科(2)。另一份報告顯示,SPM在兒童中的發病率為1:11726,在急診科在台灣中部(3)。然而,SPM的實際發生率是未知的,因為在臨床和放射學表現可以是subtl.The常見臨床表現的SPM包括胸痛(89%),呼吸困難(67%),吞嚥困難(18%),和頸部疼痛(11 %)(4)。氣胸並沒有在我們的患者中觀察到。 62例SPM回顧性審查確定的32%患者同時合併氣胸。有可能是因為先前存在的肺部疾病的患者年事已高(5)的患病率較高的氣胸在這項研究率高

    在此本例中,臨床圖像顯示在頸部和胸壁與捻發音皮下氣腫。在一個報告中,SPM的診斷胸片作出單獨(6)。在另一份報告中,33例SPM的70%的胸部radiograpy被確定,剩下的30%被發現胸部CT掃描(7)胸部.Computed斷層掃描可幫助確立診斷時,胸部X線檢查是模糊的鑑定SPM.In發表過評論,一個18例SPM經歷並發症和接受外科手術治療(4)。慢跑誘導氣腫應從其他危及生命的情況,如食管破裂或支氣管穿孔加以區分。它的SPM和次級氣腫,如布爾哈弗綜合徵區分是重要的。二次縱隔氣腫與創傷性胸部損傷或胸腔疾病相關,並有可能成為氣胸高incidience,如果不立即診斷預後較差。在我們的病人,SPM及皮下氣腫是慢跑後罕見sequelare。在這種情況下,本的可能的病理生理學可能是增加的發展

    參考資料: google
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