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Diagnostisches und therapeutisches Vorgehen beim spontanen Emphysem der Halsweichteile und des Mediastinums

Diagnostic and therapeutic procedure for spontaneous emphysema of the neck and mediastinum

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Zusammenfassung

Hintergrund

Emphyseme ohne erkennbare Ursache stellen eine diagnostische und therapeutische Herausforderung dar.

Patienten

In 5 Jahren haben wir 4 Patienten von 3–29 Jahren mit einem Emphysem der Halsweichteile und des Mediastinums stationär betreut.

Ergebnisse

Ohne anamnestische Hinweise auf die Genese haben wir 2 Patienten zunächst nur stationär beobachtet und nach Abklingen des Emphysems endoskopische Diagnostik durchgeführt. 2 Patienten mit Hustenattacken undfraglicher Fremdkörperingestion in der Anamnese wurden am Aufnahmetag endoskopiert und antibiotisch abgeschirmt. Bei allen bildet sich das Emphysem vollständig und komplikationslos zurück.

Fazit

Falls anamnestisch und durch Bildgebung ein Fremdkörper oder Trauma ausgeschlossen werden, sollte die Endoskopie des Luft- und Speiseweges erst nach der komplikationslosen Rückbildung des Emphysems durchgeführt werden. Ziel ist es, eine weitere Ausbreitung des Emphysems und eine mögliche Keimverschleppung zu vermeiden. Bei Hinweisen auf eine Fremdkörperingestion oder ein Trauma ist jedoch eine sofortige Endoskopie indiziert.

Abstract

Background

Emphysema without any etiological indices from the history represents a diagnostic and therapeutic challenge.

Patient collective

Over the last 5 years, we treated four patients (three male, one female; aged 3–29 years) with cervical and/or mediastinal emphysema of unknown cause.

Results

Two young men with cervical emphysema were observed and received prophylactic antibiotic treatment. After involution of the emphysema, we performed an endoscopy which revealed no abnormalities. A female patient and a 3-year-old boy had a history of coughing and a query history of foreign body ingestion before the appearance of the emphysema. The immediate endoscopies were without pathologic findings. All patients recovered completely without any complications or recurrences.

Conclusions

If there is no indication for a foreign body or a trauma in the history or in radiological imaging, endoscopy of the airways and the upper digestive tract should follow when the emphysema has subsided. The aim is to avoid any further spread of the emphysema and of pathogens. If there is a history of a foreign body or trauma, an immediate endoscopy is indicated.

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Authors and Affiliations

  1. HNO-Klinik der Friedrich-Schiller-Universität Jena

    S. Koscielny

  2. Klinik für Anästhesiologie und Intensivtherapie der Friedrich-Schiller-Universität Jena

    R. Gottschall

  3. HNO-Klinik der Friedrich-Schiller-Universität Jena, Lessingstraße 2, 07740, Jena

    S. Koscielny

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  1. S. Koscielny
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  2. R. Gottschall
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Correspondence to S. Koscielny.

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Koscielny, S., Gottschall, R. Diagnostisches und therapeutisches Vorgehen beim spontanen Emphysem der Halsweichteile und des Mediastinums. HNO 53, 645–650 (2005). https://doi.org/10.1007/s00106-004-1175-0

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  • DOI: https://doi.org/10.1007/s00106-004-1175-0

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