Zusammenfassung
Hintergrund
Emphyseme ohne erkennbare Ursache stellen eine diagnostische und therapeutische Herausforderung dar.
Patienten
In 5 Jahren haben wir 4 Patienten von 3–29 Jahren mit einem Emphysem der Halsweichteile und des Mediastinums stationär betreut.
Ergebnisse
Ohne anamnestische Hinweise auf die Genese haben wir 2 Patienten zunächst nur stationär beobachtet und nach Abklingen des Emphysems endoskopische Diagnostik durchgeführt. 2 Patienten mit Hustenattacken undfraglicher Fremdkörperingestion in der Anamnese wurden am Aufnahmetag endoskopiert und antibiotisch abgeschirmt. Bei allen bildet sich das Emphysem vollständig und komplikationslos zurück.
Fazit
Falls anamnestisch und durch Bildgebung ein Fremdkörper oder Trauma ausgeschlossen werden, sollte die Endoskopie des Luft- und Speiseweges erst nach der komplikationslosen Rückbildung des Emphysems durchgeführt werden. Ziel ist es, eine weitere Ausbreitung des Emphysems und eine mögliche Keimverschleppung zu vermeiden. Bei Hinweisen auf eine Fremdkörperingestion oder ein Trauma ist jedoch eine sofortige Endoskopie indiziert.
Abstract
Background
Emphysema without any etiological indices from the history represents a diagnostic and therapeutic challenge.
Patient collective
Over the last 5 years, we treated four patients (three male, one female; aged 3–29 years) with cervical and/or mediastinal emphysema of unknown cause.
Results
Two young men with cervical emphysema were observed and received prophylactic antibiotic treatment. After involution of the emphysema, we performed an endoscopy which revealed no abnormalities. A female patient and a 3-year-old boy had a history of coughing and a query history of foreign body ingestion before the appearance of the emphysema. The immediate endoscopies were without pathologic findings. All patients recovered completely without any complications or recurrences.
Conclusions
If there is no indication for a foreign body or a trauma in the history or in radiological imaging, endoscopy of the airways and the upper digestive tract should follow when the emphysema has subsided. The aim is to avoid any further spread of the emphysema and of pathogens. If there is a history of a foreign body or trauma, an immediate endoscopy is indicated.
Literatur
Badaoui R, El Kettani C, Fikri M, Ouendo M, Canova-Bartoli P, Ossart M (2002) Spontaneous cervical and mediastinal air emphysema after ecstasy abuse. Anesth Analg 95: 1123
Benito JI, Marcos M, Morais D, Perez R (1995) Spontaneous cervical and mediastinal emphysema. Acta Otorinolaringol Esp 46: 152–156
Boudy SL, Miller FB, Bumpous JM (2002) Neck crepitance: Evaluation and management of suspected upper aerodigestive tract injury. Laryngoscope 112: 791–795
Bouwen L, Bosmans E (1997) Posttraumatic pneumomediastinum: not always cause for alarm. Acta Chir Belg 3: 145–147
Bratton SL, O’Rourke PP (1993) Spontaneous pneumomediastinum. J Emerg Med 11: 525–529
Calvo Romero JM (2000) Spontaneous pneumomediastinum and idiopathic pulmonary fibrosis. An Med Interna 17: 655–656
Chalumeau M, Le Clainche L, Sayeg N et al. (2001) Spontaneous pneumomediastinum in children. Pediatr Pulmonol 31: 67–75
Chapdelaine J, Beaunoyer M, Daigneault P, Berube D, Butter A, Ouimet A, St-Vil D (2004) Spontaneus pneumomediastinum: Are we overinvestigating? J Pediatr Surg 39: 681–684
Choo MJ, Shin SO, Kim JS (1998) A case of spontaneous cervical and mediastinal emphysema. J Korean Med Sci 13: 223–226
Cruz de la MI, Reyes Nunez N, Rojas Box JL (2000) Spontaneous pneumomediastinum in cocaine user. Arch Bronchopneumol 4: 231
Dhrampal A, Jenkins J (2001) Spontaneous cervical and mediastinal emphysema following childbirth. Anaesthesia 56: 93–94
Frenkel MA, Lyons LL (1991) Spontaneous pneumomediastinum. An unusual cause of a sore throat. Postgrad Med 89: 257–259
Gurtner B (1991) Dissecting emphysema. Schweiz Rundsch Med Prax 80: 1203–1208
Goudy SL, Miller FB, Bumpous M (2002) Neck crepitance: Evaluation and Management of suspected upper aerodigestives tract injury. Laryngoscope 112: 791–795
Hamman L (1939) Spontaneuos mediastinal emphysema. Bull John Hopkins Hosp 64: 1–21
Harley EH (1987) Spontaneous cervical and mediastinal emphysema in asthma. Arch Otolaryngol Head Neck Surg 113: 1111–1112
Hur T, Chen Y, Shu GH, Chang JM, Cheng KC (1995) Spontaneous cervical subcutaneous and mediastinal emphysema secondary to occult sigmoid diverticulitis. Eur Respir J 8: 2188–2190
Jouon JB, Ballester M, Delcambre F, Mac Bride T, Dromer CE, Vel JF (2003) Asessment of spontaneous pneumomediastinum: experience with 12 patients. Ann Thorac Surg 75: 1711–1716
Kaneki T, Kubo K, Kawashima A; Koizumi T, Sekiguchi M, Sone S (2000) Spontaneous pneumomediastinum in 33 patients. Yield of chest computed tomography for the diagnosis of the mild type. Respiration 67: 408–411
Kannath PG, Jadhav UG (2002) Primary spontaneous pneumomediastinum. J Assoc Physicians India 50: 613
Kobashi Y, Okimoto N, Matsushima T, Soejima R (2002) Comparative study of mediastinal emphysema as determined by ethiology. Intern Med 41: 277–282
Koullias GJ, Korkolis DP, Wang XJ, Hammond GL (2004) Current assessment and management of spontaneus pneumomediastinum: experience in 24 adult patients. Eur J Cardothorac Surg 25: 852–855
Kucukosmanoglu O, Karakoc GB, Yilmaz M, Altintas D, Guneser Kendirli S (2001) Pneumomediastinum and pneumopericardium: unusual and rare complications of asthma in a 4 year old girl. Allergol Immunopathol (Madr) 29: 28–30
Lantsberg L, Rosenzweig V (1992) Pneumomediastinum causing pneumoperitoneum. Chest 101: 1176
Lemaire V, Gielen S, Lebrun F, Bury F (2001) Pneumomediastinum in children. Rev Med Liege 56: 415–419
Liechti ME, Achermann E (2002) Das Pneumomediastinum. Dtsch Med Wochenschr 127: 2273–2276
Liechti ME, Achermann E, Gerber D, Nolinth TS (2002) Pneumomedistinum nach Zahnextraktion. Schweiz Rundschr. Med Prax 91: 1173–1174
Liang SG, Ooka F, santo A, kalibara M (2002) pneuomedistinum following oesophageal rupture associated wit hyperemesis gravidarum. J Obestet Gynaecol Res. 28: 172–175
Lopez-Pelaez MF, Roldan J, Mateo S. (2001) Cervical emphysema, pneumomediastinum, and pneumothorax following self-induced oral injury: report of four cases and review of the literature.Chest120: 306–309
Meisner M (200) Procalcitonin (PCT), 3. überarbeitete und erweiterte Aufl. Thieme, Stuttgart
Miura H, Taira O, Hiraguri S, Ohtani K, Kato H (2003) Clinical features of medical pnemomediastinum. Ann Thorac Cardiovasc Surg 9: 188–191
Munch-Petersen L, Kjaergard HK (1992) Pneumomediastinum. Ugeskr Laeger 154: 2004-2007
Parker GS, Mosborg DA, Foley RW, Stiernberg CM (1990) Spontaneous cervical and mediastinal emphysema. Laryngoscope 100: 938–940
Platov II, Moiseev VS (1998) Spontaneous pneumomediastinum. Probl Tuberk 5: 61–62
Polosa R, Scire G, Vancheri C, Crimi N (1999) Spontaneous pneumomediastinum with subcutaneous emphysema: unusual presenting feature of a common condition. Monaldi Arch Chest Dis 54: 330–331
Pretre R, Rohner A (1992) Pneumomediastinum and subcutaneous cervical emphysema as signs of rectosigmoid perforation. Gastroenterol Clin Biol 16: 460–462
Raith W, Zartner P, Beitzke A (2003) Spontanes Pneumomediastinum. Z Kardiol 92: 601–605
Raley JC, Andrews JI (2001) Spontaneous pneumomediastinum presenting as jaw pain during labor. Obstet Gynecol 98: 904–906
Shockley WW, Tate JL, Stucker FJ (1985) Management of perforations of the hypopharynx and cervical esophagus. Laryngoscope 95: 939–941
Siewert J, Feussner H (1996) Chirurgie des zervikalen Ösophagus. In: Herberhold C, Panje WR (Hrsg) Kopf-Hals-Chirurgie, Bd 3. Thieme, Stuttgart
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Koscielny, S., Gottschall, R. Diagnostisches und therapeutisches Vorgehen beim spontanen Emphysem der Halsweichteile und des Mediastinums. HNO 53, 645–650 (2005). https://doi.org/10.1007/s00106-004-1175-0
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DOI: https://doi.org/10.1007/s00106-004-1175-0