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2017, Número 4

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Acta Med 2017; 15 (4)


Neumomediastino espontáneo. Revisión con un caso ilustrativo

Arellano AG, Mora CJ, Magaña RJ, Diez SGJH, Domínguez CLG

Idioma: Español
Referencias bibliográficas: 68
Paginas: 287-295
Archivo PDF: 240.10 Kb.


RESUMEN

Introducción: El neumomediastino espontáneo es una entidad poco frecuente que afecta con mayor frecuencia a varones jóvenes de entre 18 y 25 años de edad. Caso clínico: Masculino de 20 años, con antecedentes de tabaquismo desde los 16. Acudió por dolor retroesternal, transfictivo, irradiado a la región interescapular, que se incrementa con la inspiración, secundario a un acceso de tos. A la exploración: estatura 1.85 m; peso 87 kg; IMC 25.42; FC 85 lat./min; FR 18/min; TA 120/80; Temp. 36.6 oC; cuello normal; en el tórax, ruidos cardiacos rítmicos acompañados de crujido áspero sincrónico con el ritmo cardiaco, campos pulmonares con murmullo vesicular normal; resto normal, electrocardiograma normal y troponina cardiaca seriada indetectable. La tomografía de tórax mostró presencia de aire en el mediastino, extendiéndose caudalmente a la aorta descendente y a los vasos supraaórticos. Con el diagnóstico de neumomediastino espontáneo, se le manejó con reposo, analgésicos y oxígeno, 3 litros/min por 72 horas. Fue dado de alta asintomático. Conclusiones: El neumomediastino espontáneo es benigno y autolimitado, afecta a niños y adultos jóvenes; es ocasionado por asma, infecciones respiratorias, vómitos y/o tos intensa, y esfuerzos físicos con maniobras de Valsalva.


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