書誌事項
- タイトル別名
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- An autopsy case of bronchial asthma complicated with severe pneumomediastinum, extensive subcutaneous emphysema pneumothorax and pneumoperitoneum.
説明
A 63-year-old man was admitted to our hospital because of severe dyspnea and found swelling of face on February 16, 1987. He had had brochial asthma since age 48. On admission, the patient was orthopneic with marked dyspnea. The respiration was rapid at 30per minute. The pulse rate was 110per minute and regular. The blood pressure was 180/100mmHg. Subcutaneous emphysema of the face, neck, chest, abdomen, scortum, femur and knee was accompanied by crepitation. The heart sound was diminished because of pneumothorax and subcutaneous emphysema on the chest. Hamman's sign was not recognised. Piping rales were heard on the chest with the prolongation of expiration on auscultation. On inspiring 31/min oxygen, his arterial PaO2 value was 58.6 torr and his arterial PaCO2 value 48.0 torr. The radiologic examination of the chest showed severe mediastinal and subcutaneous emphysema. The chest computed tomography (CT) scan also showed severe mediastinal and subcutaneous emphysema, and bilateral pneumothorax, but did not showed bleb or bulla. The radiologic examination of the abdomen showed pneumoperitoneum. Treatments with oxygen inhalation by ventimask, bronchodilator and corticosteroid were performed immediatly on admission. However, extensive subcutaneous emphysema, congestion on face, cyanosis and dyspnea developed rapidly, so intratracheal intubation and the artificial respiration were carried out. Incisions were made in the supraclavicular fossa and in the chest, but he died from respiratory and circulatory failure 1.5 hours after admission. Autopsy was performed. Macroscopically, severe systemic subcutaneous emphysema, facial congestion and cyanosis were observed. The thoracic cavity was filled with air. The bilateral lungs were collapsed and tension pneumothorax was observed on the right side. Mediastinal emphysema was severe, and emphysema was observed around the esophagus and the pericardium. In the peritoneal cavity, free air was observed. Emphysema was observed in the peritoneum, in the serosa of the stomach and the gastrocolic omentum. It is of interst that severe pneumomediastinum, extensive subcutaneous emphysema, pneumothorax and pneumoperitoneum were observed in this case of bronchial asthma. No similar case has been reported in the literature.
収録刊行物
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- 日本胸部疾患学会雑誌
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日本胸部疾患学会雑誌 26 (5), 554-558, 1988
社団法人 日本呼吸器学会
