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[NEJM临床医学影像]:捻发音与皮下气肿
2020年01月25日 临床影像, 临床话题 暂无评论

IMAGES IN CLINICAL MEDICINE

Crepitus and Subcutaneous Emphysema

Yehia Saleh and Ahmad Alratroot

N Engl J Med 2020; 382:e1
DOI: 10.1056/NEJMicm1907386

An 86-year-old woman with a history of severe emphysema presented to the emergency department with sudden-onset shortness of breath. Two weeks earlier, she had been treated for community-acquired pneumonia that was complicated by a pneumothorax on the right side, leading to the temporary insertion of a chest tube. The drain was removed before the patient was discharged, without complication. On examination during the current presentation, the oxygen saturation was 82% while the patient was breathing ambient air, and breath sounds were diminished in the right hemithorax. Extensive palpable crepitus could be clearly visualized in the neck (see video). Findings on computed tomography of the chest included emphysematous changes in the lungs, a moderate pneumothorax on the right side, and extensive subcutaneous emphysema. A chest tube was reinserted; however, the patient’s clinical status continued to deteriorate, and ultimately a decision was made to pursue comfort care.

一名严重肺气肿病史的86岁女性患者因突发呼吸困难到急诊科就诊。2周前,患者因社区获得性肺炎并发右侧气胸接受治疗,并留置右侧胸管。患者出院前拔除胸管,且无任何并发症。此次就诊时体格检查发现,患者吸入空气时氧饱和度82%,右侧呼吸音减低。颈部可见广泛气肿表现。胸部CT发现肺内气肿改变,右侧中等量气胸,广泛皮下气肿。再次置入胸管;然而,患者病情持续恶化,最终决定采取和缓治疗措施。

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