新英格兰NEJM：成人会厌炎
一位65岁既往体健女性因咽喉痛，声音低沉和自我感觉发热7天而就诊于急诊科。体格检查示：患者体温正常，血压140/86mmHg，血氧饱和度正常(98%)。患者前颈部轻度肿胀并伴有压痛，颈部淋巴结未触及肿大，患者无流涎。X线示颈外侧软组织「拇指片」影(图A箭头所示)，表明患者有会厌肿胀，提示会厌炎。CT示实体肿胀以及会厌部(图B箭头所示)，舌根和舌扁桃体水肿。间接喉镜检查示会厌和舌根出现红斑和炎症，从而出现舌扁桃体的肥大，喉部再现痰。因可能出现气道阻塞的可能，给予患者头孢曲松钠和地塞米松治疗，并留观了48小时。患者血培养一直为阴性。第3天患者症状消失，患者可以进食。患者出院后给予头孢呋辛治疗1周。
A previously healthy 65-year-old woman presented to the emergency department with a 7-day history of throat pain, difficulty swallowing, muffled voice, and subjective fevers. On presentation, she was afebrile and hemodynamically stable with normal oxygen saturation (blood pressure, 140/86 mm Hg; oxygen saturation, 98% while the patient was breathing ambient air). Physical examination revealed mild tenderness and swelling in the anterior neck, without cervical lymphadenopathy or drooling. Lateral soft-tissue radiography of the neck showed the “thumb sign” (Panel A, arrow), indicating a swollen epiglottis, suggestive of epiglottitis. Computed tomography of the neck revealed substantial swelling and edema of the epiglottis (Panel B, arrow), the base of the tongue, and the lingual tonsil. Indirect laryngoscopy revealed erythema and inflammation of the epiglottis and the base of the tongue, with clinically significant hypertrophy of the lingual tonsil and phlegm in the throat. Ceftriaxone and dexamethasone were initiated, owing to the risk of airway compromise. The patient was monitored closely in the hospital for 48 hours. Blood cultures remained negative. The patient’s symptoms improved, and within 3 days after presentation, she was able to consume an oral diet. She was discharged home to complete 1 additional week of antimicrobial treatment with oral cefuroxime.
原文：http://www.nejm.org/doi/full/10.1056/NEJMicm1400061#figure=f1
Epiglottitis in an Adult
A previously healthy 65-year-old woman presented to the emergency department with a 7-day history of throat pain, difficulty swallowing, muffled voice, and subjective fevers. On presentation, she was afebrile and hemodynamically stable with normal oxygen saturation (blood pressure, 140/86 mm Hg; oxygen saturation, 98% while the patient was breathing ambient air). Physical examination revealed mild tenderness and swelling in the anterior neck, without cervical lymphadenopathy or drooling. Lateral soft-tissue radiography of the neck showed the “thumb sign” (Panel A, arrow), indicating a swollen epiglottis, suggestive of epiglottitis. Computed tomography of the neck revealed substantial swelling and edema of the epiglottis (Panel B, arrow), the base of the tongue, and the lingual tonsil. Indirect laryngoscopy revealed erythema and inflammation of the epiglottis and the base of the tongue, with clinically significant hypertrophy of the lingual tonsil and phlegm in the throat. Ceftriaxone and dexamethasone were initiated, owing to the risk of airway compromise. The patient was monitored closely in the hospital for 48 hours. Blood cultures remained negative. The patient’s symptoms improved, and within 3 days after presentation, she was able to consume an oral diet. She was discharged home to complete 1 additional week of antimicrobial treatment with oral cefuroxime.
原文：http://www.nejm.org/doi/full/10.1056/NEJMicm1400061#figure=f1
评论
发表评论
欢迎交流指正