急性纵隔炎临床与影像学特征分析

Clinical and Radiological Analysis of Acute Mediastinitis

[目的]探讨急性纵隔炎临床及影像学特征.[方法]收集本院2010年9月至2011年8月诊治的急性纵隔炎5例,对其病因、临床和影像学表现以及治疗转归进行总结,分析急性纵隔炎的临床、影像学特点、诊治要点及预后.[结果]5例患者病因：1例患者为冠心病行冠状动脉搭桥术术后并发症,1例为车祸外伤所致,1例为食管异物导致食管穿孔所致,1例为口咽部感染所致的急性下行性纵隔炎,1例无明确诱因;临床表现：发热（100%,5/5）、胸痛（80%,4/5）及呼吸困难（80%,4/5）最为常见;5例患者中并发感染性休克者2例,并发心功能不全1例,并发多器官功能障碍综合征3例;影像学表现以纵隔内出现气体及低密度渗出影像为特点;5例患者死亡3例,好转2例.[结论]急性纵隔炎的症状缺乏特异性,病死率高,但其影像学具有一定特点.因此,对有发生急性纵隔炎危险因素的患者的仔细评估和及时进行相关影像学检查将有利于早期诊断.

[Objective] To explore the clinical and radiological features of acute mediastinitis. [Methods] Five patients with acute mediastinitis in our hospital from Sept. 2010 to Aug. 2011 were collected. The etiology, clinical and radiologi- cal manifestations, treatment and the prognosis were summarized. The clinical and radiological features, the main points of diagnosis and treatment and the prognosis of acute mediastinitis were analyzed. [Results]The etiology of 5 patients were postoperative complication of coronary artery bypass of coronary heart disease in one patient, the trauma caused by road accident in one patient, esophageal perforation causes by foreign body in one patient, acute descent mediastinitis caused by pharynx oralis infection in one patient and unknown origin in one patient. The most common clinical manifesta- tions were fever（100 %, 5/5）, chest pain（80%, 4/5） and dyspnea（80%, 4/5）. Among 5 patients, 2 patients were com- plicated with infectious shock, one patient was complicated with cardiac dysfunction（1/5） and 3 patients were complicated with MODS. Radiological features were gas shadow or low density of effusion image. Of 5 patients, 3 patients died and 2 patients got better. [Conclusion] Acute mediastinitis have non-specific symptoms and high morbidity, but the radiological manifestations have some features. Therefore, careful evaluation and prompt radiological examination are helpful for the early diagnosis of patients with high risk of acute mediastinitis.