Neumomediastino espontneo: reporte de un caso y revisin de la literatura

摘要

El neumomediastino espontneo o enfisema mediastinal es una condicin rara en nios, generalmente benigna y autolimitada, causada por la ruptura alveolar y diseccin de aire al espacio mediastinal. Es ms comn en nios asmticos, pero puede ocurrir en cualquier paciente que induzca una maniobra de Valsalva. Los signos clnicos son disnea, dolor torcico y enfisema subcutneo. Su diagnstico se realiza por sospecha clnica y se confirma con los rayos X de trax. El tratamiento es sintomtico y conservador. Este artculo le permitir al clnico familiarizarse con los sntomas clnicos especficos y los signos radiolgicos asociados. Se presenta el caso de una paciente de 12 aos de edad que consulta al servicio de urgencias por dolor torcico y disnea luego de haber realizado un esfuerzo excesivo. Al examen fsico se encontr enfisema subcutneo y se diagnostica neumomediastino espontneo con la ayuda de los rayos X de trax. Se hace manejo de soporte y resuelve a los 15 das. ABSTRACT Spontaneous pneumomediatinum is a rare, generally benign and self-limited condition in children, caused by alveolar rupture and dissection of air into the mediastinum. In children, is seen most commonly in asthmatics but may also occur in any patient who induces a Valsalva maneuver. Clinical signs may include dyspnea, chest pain and subcutaneous emphysema. Diagnosis is made upon clinical suspicion and confirmed by chest x-rays. Treatment is symptomatic and conservative. This article will allow the clinician to become familiar with the specific clinical and radiological signs of this disease. We report a case of a 12 year-old girl who developed spontaneous neumomediastinum and subcutaneous emphysema after lifting heavy weight. The patient presented to the emergency department with chest pain and dyspnea. The initial physical exam was positive for subcutaneous emphysema. The chest x-rays confirmed the clinical suspicion of spontaneous pneumomediatinum. The patient symptoms were completely resolved after two weeks of supportive management.