Pnömomediastinumlarýn klinik deneyimlere dayalý olarak karþýlaþtýrýlmasý

AMAÇ: Pnömomediastinum (PM) mediastende hava varlýðýný tanýmlayan terimdir. Ayrýca mediastinal anfizem olarakta tanýmlanmýþtýr. PM, spontan PM (SPM) ve sekonder PM (ScPM) olarak adlandýrýlan iki alt gruba ayrýlýr.
GEREÇ VE YÖNTEM: Þubat 2010 ve Temmuz 2018 arasýnda taný konulan PM’nin karþýlaþtýrmalý geriye dönük bir çalýþmasý sunuldu. Kýrk hasta karþýlaþtýrýldý. Hasta öyküsü, fiziksel özellikleri, semptomlarý, muayene bulgularý, hastanede kalýþ süresi, tedavileri, klinik süreci, nüks ve komplikasyonlarý ile ilgili klinik veriler dikkatli bir þekilde araþtýrýldý. SPM, travmatik PM (TPM) ve iyatrojenik PM (IPM) olan hastalar karþýlaþtýrýldý.
BULGULAR: SPM 14 hastada (%35) tespit edildi. ScPM grubunda; 16 hastada (%40) TPM, 10 hastada (%25) iyatrojenik PM tespit edildi. SPM grubunda en sýk bildirilen semptomlar göðüs aðrýsý, dispne, subkütanöz amfizem ve öksürük idi. Tanýyý doðrulamak ve olasý bulgularý deðerlendirmek için tüm hastalara BT uygulandý. Tüm hastalara mediastiniti önlemek için profilaktik antibiyotik reçete edildi.
TARTIÞMA: Bu çalýþmanýn temel amacý, travma ve travma dýþý hastalardaki PM’lerin klinik farklýlýklarýný ve yönetimini deðerlendirmektir. Pnömomediastinumun klinik spektrumu, benign mediastinal anfizemden mediastinal yapýlarýn perforasyonu nedeniyle ölümcül bir mediastinite kadar deðiþebilir. Birçok çalýþmada sadece SPM pek çok açýdan deðerlendirilmiþtir, ancak travmatik ve travmatik olmayan PM’lerin deðerlendirmesini ve yönetimini karþýlaþtýran daha az çalýþma vardýr. Sadece toraks bölgesine sýnýrlý travma geçiren ve görüntüleme çalýþmalarýnda mediastinal organ hasarý olmadýðý gösterilen TPM’li hastalar, mediastinal organ yaralanmasýna sahip olmayan SPM hastalar gibi takip ve tedavi edilebilir.

A comparative study of pneumomediastinums based on clinical experience

BACKGROUND: Pneumomediastinum (PM) is the term which defines the presence of air in the mediastinum. PM has also been described as mediastinal emphysema. PM is divided into two subgroups called as Spontaneous PM (SPM) and Secondary PM (ScPM).
METHODS: A retrospective comparative study of the PM diagnosed between February 2010 and July 2018 is presented. Forty patients were compared. Clinical data on patient history, physical characteristics, symptoms, findings of examinations, length of the hospital stay, treatments, clinical time course, recurrence and complications were investigated carefully. Patients with SPM, Traumatic PM (TPM) and Iatrogenic PM (IPM) were compared.
RESULTS: SPM was identified in 14 patients (35%). In ScPM group, TPM was identified in 16 patients (40%), and IPM was identified in 10 patients (25%). On the SPM group, the most frequently reported symptoms were chest pain, dyspnea, subcutaneous emphysema and cough. CT was performed to all patients to confirm the diagnosis and to assess the possible findings. All patients prescribed prophylactic antibiotics to prevent mediastinitis.
CONCLUSION: The present study aimed to evaluate the clinical differences and managements of PMs in trauma and non-trauma patients. The clinical spectrum of pneumomediastinum may vary from benign mediastinal emphysema to a fatal mediastinitis due to perforation of mediastinal structures. In most series, only the SPM was evaluated in many aspects, but there are fewer studies comparing the evaluation and management of traumatic and non-traumatic PMs. The patients with TPM who have limited trauma to the thorax and who do not have mediastinal organ injury in their imaging studies can be followed up and treated like SPM patients who do not have mediastinal organ injury, and both have good clinical course.