腮腺积气(Pneumoparotid)CT病例图片影像诊断分析

口咽腔   2011-01-11

 【临床病史】:患者,15岁,出现头痛和急剧恶化的精神状态。15-year-old with headaches and acutely worsening altered mental status.

【影像图片】CT图像


【影像表现】

Figure 1: Noncontrast head CT in brain window demonstrates no other abnormality.

Figure 2: Noncontrast head CT demonstrates small foci of gas within the right parotid gland. The parotid gland is otherwise normal without any definite inflammatory changes.

平扫CT显示在右侧腮腺内小点状低密度气体影,腮腺内没有明显的炎性改变

【影像诊断】:Pneumoparotid 腮腺积气

【诊断要点】:Pneumoparotid can be an incidental finding or associated with acute or chronic unilateral or bilateral parotid gland swelling  腮腺积气可以是偶然发现或伴有急性或慢性的单侧或双侧腮腺肿胀。

    Pneumoparotid is caused by increased intraoral pressure and reflux of air into the parotid gland via Stensen's duct and multiple mechanisms have been reported.腮腺肿胀是由于口腔内压力增高导致空气通过腮腺导管倒流至腮腺内,有多种发病机制被报道;

    Symptoms usually resolve in a few days.  Most authors suggest treatment with prophylactic antiobiotics. Surgical intervention is reserved for chronic, recurrent cases. 症状通常在数天后消退,大多数的作者建议预防性的使用抗生素。外科手术被用于慢性和复发性病例。

 【讨论】:Pneumoparotid (also called pneumoparotitis and pneumoparotidis) refers to air within the parotid gland without any demonstrable inflammation or infection. This is caused by reflux of intra-oral air into the parotid gland through Stenson's duct. It is associated with any process that significantly increases intra-oral pressure. Intra-oral pressure must increase enough to overcome the small, slit like orifice of Stensen's duct with surrounding redundant mucosal folds that normally prevent reflux of salvia and air into the duct and the parotid gland.

    腮腺积气(也被称为气肿性腮腺炎)指的是腮腺内出现空气而不伴有任何明显的炎性或感染灶。这是由于口腔内压力增高导致空气通过腮腺导管进入腮腺内所致,多伴有任何可以导致口腔内压力明显增高的进程。口腔内压力增高到足够突破那些类似于腮腺导管开口的小裂隙,这些裂隙环绕在粘膜皱襞周围,正常情况下阻止了salvia和空气进入至导管和腮腺。

    Iatrogenic causes, underlying medical conditions, occupational hazards and self-induced mechanisms have been reported. Iatrogenic causes include: dental instrumentation, general anesthesia with endotracheal intubation, spirometry. Pneumoparotid has been descibed with conditions associated with chronic cough including COPD, cystic fibrosis and allergic rhinitis. Additionally, wind instrument players, SCUBA divers and glass blowers can develop this condition. Finally, pneumoparotid has been reported to be self-induced to simulate mumps to avoid school or military duty and in children who obsessively puff their cheeks in response to psychological stress.

    其发病机制包括医源性因素、潜在的病变状况、职业因素和自发性。医源性因素包括:牙科器械、气管插管行全身麻醉、肺活量测定。腮腺积气也在一些有慢性咳嗽的状况下出现,包括COPD、囊性纤维化和变应性鼻炎。另外,管乐器吹奏者、水下呼吸器操作者和玻璃吹制工都可以出现这种情况。最后,某些人通过持续性鼓起面颊(儿童可能是心理学应激所致)导致自发性的腮腺积气以类似于腮腺炎,从而逃避服兵役或逃学。

    If intra-oral pressure increases adequately, often in the setting of chronic or recurrent cases, rupture of air through parotid acini and dissection into surrounding soft tissues including the retropharyngeal space, facial and neck soft tissues as well as pneumomediastinum can occur.

    假如口腔内压力增高到足够高的时候,可以导致空气通过腮腺腺泡破裂,并进入至周边的软组织包括咽后间隙,从而引起颈面部和纵隔气肿,这常常发生在慢性或复发性病例。

    Pneumoparotid can be an incidental finding as in the current case or associated with unilateral or bilateral parotid swelling. The swelling is generally painless, however occasionally can be tender with associated mild warmth and erythema. Crepitus and air bubbles at Stensen's duct with palpation may be observed at physical examination. Symptoms usually resolve spontaneously in a few days. Occasionally this process can be recurrent and lead to superimposed infection and/or inflammation secondary to reflux of oral bacteria and some authors recommend treatment with prophylactic antibiotics. Treatment also involves avoidance of further increases in intra-oral pressure. Surgery is indicated only in chronic and recurrent cases.

    腮腺积气可以是偶然发现,就像本例一样,或者伴有单侧或双侧的腮腺肿胀,这种肿胀通常是无痛性的,然而偶尔也可以是有触痛伴有轻微的发热和红斑。体格检查时可以触及捻发音和腮腺导管内气泡。症状通常在数天后自行消退。偶尔病程可以反复并且导致重复感染和/或继发于口腔细菌返流所致的感染,因此一些作者认为需要预防性的使用抗生素。治疗也要包括防止口腔内压力的进一步增高。外科手术仅用于慢性和复发性病例。

(参考来源:,医影志ACR, February, 2010,作者:freemanpyw编译)
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