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[NEJM临床影像]:减压病
2017年11月25日 临床影像, 临床话题 暂无评论

Images in Clinical Medicine

Decompression Sickness

N Engl J Med 2017; 377: 1568

Qing Sun, Guangkai Gao

DOI:10.1056/NEJMicm1615505

A  42-year-old man presented to the emergency department with palpitations, arthralgias, and vomiting 2 hours after scuba diving to a depth of 26 m. The physical examination revealed diffuse violaceous skin mottling over his trunk and arms (Panel A). Laboratory values were notable for mild elevations in levels of serum aminotransferases, creatine kinase, and lactate. Given the extent of the nausea and vomiting as well as the elevated lactate level, abdominal computed tomography was performed, which showed air in the portal venous system (Panel B). The skin mottling, also known as cutis marmorata, is a recognized dermatologic manifestation of decompression sickness. Air in the portal venous system can also be a complication of decompression sickness. Its incidence is unknown, since abdominal imaging is not routinely performed for this diagnosis. The air in the portal system is thought to arise when a diver ascends too quickly and air expands rapidly, which damages the surrounding tissue. The patient underwent treatment with hyperbaric oxygen. The skin mottling and abdominal pneumatosis resolved after two sessions in the hyperbaric chamber.

一名42岁男性患者在戴呼吸器潜水26米深度后心悸、关节痛及呕吐2小时就诊于急诊科。体格检查发现躯干及上臂皮肤弥漫性紫色花斑(图A)。实验室检查显示血清转氨酶、肌酸激酶和乳酸水平轻度升高。由于患者出现恶心呕吐及乳酸升高,行腹部CT显示门静脉系统积气(图B)。皮肤花斑,又称大理石色皮肤,是减压病常见的皮肤表现。门静脉系统积气也是减压病的并发症之一。发病率尚不清楚,因为减压病患者并不常规进行腹部影像学检查。门静脉系统积气可能源于潜水者上升速度过快,气体迅速播散,从而损伤周围组织。患者接受了高压氧治疗。经过两次高压氧治疗后,皮肤花斑及腹部积气消失。

 

 

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