Spontanes Pneumomediastinum (Hamman-Syndrom) mit Pneumorrhachis als seltene Ursache für akuten Thoraxschmerz bei einem jungen Patienten mit akut exazerbiertem Asthma bronchiale

Zusammenfassung

Das Pneumomediastinum, definiert als Luft im mediastinalen Interstitium, ist eine seltene Ursache des akuten Thoraxschmerzes. Die Erkrankung kann sowohl sekundär als Folge von Traumata oder medizinischen Interventionen als auch spontan auftreten. Die spontan auftretende Variante (Hamman-Syndrom) hat i.d.R. auch ohne Intervention eine gute Prognose, zugrundeliegende Ursachen wie gastrointestinale Perforationen müssen jedoch ausgeschlossen werden. Diagnostisch ist neben einer konventionellen Röntgenaufnahme des Thorax eine Computertomografie oft hilfreich. Häufig tritt begleitend ein Weichteilemphysem auf, epidurale Luft im Spinalkanal wird Pneumorrhachis genannt und stellt eine seltene, jedoch ebenfalls häufig benigne Komplikation dar. Wir berichten von einem jungen Mann mit Hamman-Syndrom und Pneumorrhachis im Rahmen einer Asthma-Exazerbation, welcher trotz ausgeprägter Beschwerden rein konservativ behandelt werden konnte.

Abstract

Pneumomediastinum, defined as abnormal presence of air in the mediastinum, is a rare cause of acute chest pain. The condition may occur spontaneously as well as a secondary consequence of trauma or medical interventions. The spontaneous pneumomediastinum (Hamman’s syndrome) is associated with a good prognosis, even without intervention. However, undelying severe conditions such as gastrointestinal perforations should be excluded. Diagnosis might be made using conventionell chest x-ray; a CT scan may give additional useful information. A subcutanous emphysema is a common finding in patients with pneumomediastinum. The presence of air in the epidural space of the spinal canal (pneumorrhachis) is a rarely seen but likewise mostly benign complication. We report a case of a young man with Hamman’s syndrome and pneumorrhachis, provoked by acute asthma exacerbation; despite pronounced symptoms, his condition could be treated conservatively.

Schlüsselwörter

Pneumomediastinum - Thoraxschmerz - Mediastinalemphysem - Epidurale Pneumatosis - Dyspnoe

Keywords

Pneumomediastinum - chest pain - mediastinal emphysema - epidural pneumatosis - dyspnoea

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