自发性纵隔气肿的胸部X线诊断价值分析

目的 探讨自发性纵隔气肿的胸部X线表现.方法 回顾性分析42例自发性纵隔气肿的胸部X线表现,所有病例均经螺旋CT扫描证实.结果 42例自发性纵隔气肿中,后前位胸片表现为纵隔不同程度增宽28例;纵隔旁与纵隔轮廓边缘基本平行的线样透亮影22例;颈部、纵隔软组织内多发不规则条形透亮区30例;肩胛部软组织积气14例;心脏下方膈肌上缘连续积气1例.42例自发性纵隔气肿中,18例同时摄侧位胸片,均见胸骨后透光带、胸骨后心脏间透亮区增大.全部42病例经CT扫描均清晰显示纵隔内沿气管、支气管、食管、心脏、大血管等组织结构周围间隙内散在分布的气体影,其中前中纵隔积气42例,后纵隔积气14例;纵隔胸膜被气体向肺野方向不同程度推移.结论 X线征象中,后前位胸片纵隔增宽、颈部纵隔软组织内多发不规则条形透亮影以及膈连续征,具有一定的特征性;纵隔旁与纵隔轮廓边缘基本平行的线样透亮影、肩胛部软组织积气,在排除气胸的前提下,可支持纵隔气肿的诊断;侧位胸片胸骨后透光带、胸骨后心脏间透亮区增大,也有一定的特征性.

Evaluating the value of chest radiography in the diagnosis of spontaneous mediastinal emphysema

Objective To explore the chest radiography features of spontaneous mediastinal emphysema（SME）.Methods The pulmonary radiography features of 42 cases with SME were retrospectively analyzed.All cases were demonstrateed by spiral CT.Results On posteroanterior（PA） chest radiograpy of 42 SME cases,varied degrees of mediastinal enlargement were found in 28 cases,linear lucency shadow lying beyond mediastinum and approximately paralleling to the contour edge of mediastinum was shown in 22 cases,multiple irregular strip lucency inside the neck and mediastinum was observed in 30 cases,soft tissue pneumatosis at scapular area was found in 14 cases,and continuous gas accumulating between the heart and diagram was shown in 1 case.Among the 42 cases of SME,18 cases were taken lateral chest radiography,and retrosternal linear lucency shadow and enlarged lucency zone between sternum and heart were shown in the 18 cases.On CT scan,all the 42 cases clearly showed scatting mediastinal gases surrounding trachea,bronchi,esophagus,heart and great vessels.Among them,42 cases showed anterior mediastinal emphysema,and 14 cases displayed posterior mediastinal emphysema.Mediastinal pleurae were moved into lung field direction with varied degrees. Conclusion Of the imaging features on PA chest radiography,mediastinal enlargement,multiple irregular strip lucency inside the neck and mediastinum continuous gas accumulating between the heart and diagram are characteristic,linear lucency shadow lying beyond mediastium and approximately paralleling to the contour edge of mediastinum,and soft tissue pneumatosis at scapular area are indicative of SME under the conditions that penumothorax is excluded.On lateral chest radiography,retrosternal linear lucency shadow and enlarged lucency zone between sternum and heart are also characteristic.