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아셩 황보
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김민지 외: 미숙아에 발생한 의인성 식도천공과 기종격증 및 종격동염 A B C D E F Fig.

Chest radiograph at 6 days after birth (A) shows left

Chest radiograph taken on the next day (B) shows

loculated retrocardiac pneumomediastinum surrounding

Axial (E) and coronal (F) images, which were taken 7

2 김민지 외: 미숙아에 발생한 의인성 식도천공과 기종격증 및 종격동염 A B C D E F Fig. 1. Chest radiographs and CT scans of a premature infant. Chest radiograph at 6 days after birth (A) shows left paravertebral radiolucency at the diaphragm level. Chest radiograph taken on the next day (B) shows extended radiolucency at both paravertebral areas suggesting pneumomediastinum. Axial (C) and coronal (D) CT scans on the same day show loculated retrocardiac pneumomediastinum surrounding the esophagus and aorta. Axial (E) and coronal (F) images, which were taken 7 days after initial CT, show completely absorbed pneumomediastinum and a soft tissue mass in the same region of the retrocardiac area. 532

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4 1. Eklof O, Lohr G, Okmian L. Submucosal perforation of the esophagus in the neonate. Acta Radiol Diagn 1969;8: Grunebaum M, Horodniceanu C, Wilunsky E, Reisner S. Iatrogenic transmural perforation of the oesophagus in the preterm infant. Clin Radiol 1980;31: Clarke TA, Coen RW, Feldman B, Papile L. Esophageal perforations in premature infants and comments on the diagnosis. Am J Dis Child 1980;134: Mollitt DL, Schullinger JN, Santulli TV. Selective management of iatrogenic esophageal perforation in the newborn. J Pediatr Surg 1981;16: Amodio JB, Berdon WE, Abramson SJ, Oh KS, Oudjhane K, Wung JT. Retrocardiac pneumomediastinum in association with tracheal and esophageal perforations. Pediatr Radiol 1986;16: Blair GK, Filler RM, Theodorescu D. Neonatal pharyngoesophageal perforation mimicking esophageal atresia: clues to diagnosis. J Pediatr Surg 1987;22: Rosenfeld DL, Cordell CE, Jadeja N. Retrocardiac pneumomedi- radiographic finding and clinical implications. Pediatrics astinum: 1990;85: Stapp J, Stewart DL, Eberly S. Atypical iatrogenic perforation of the distal esophagus in an ELBW neonate. Clin Pediatr 2001;40: Lee SB, Kuhn JP. Esophageal perforation in the neonate. A review of the literature. Am J Dis Child 1976;130: Pollack A, Lask P, Kassner EG, Wood BP. Radiological case of the month. Retrocardiac pneumomediastinum. Am J Dis Child 1992; 146:

5 Mediastinitis and Pneumomediastinum in a Preterm Infant with Iatrogenic Esophageal Perforation: A Case Report 1 Min Ji Kim, M.D., Ok Hwa Kim, M.D. 1 Department of Diagnostic Radiology, College of Medicine, Ajou University Iatrogenic esophageal perforation is very rare in pediatric patients. Preterm infants or low birth weight babies are more susceptible to esophageal perforation due to performing frequent tracheal intubation and/or gastric tube installation. When perforation occurs, it may present as pneumothorax and pulmonary interstitial emphysema. However, isolated pneumomediastinum without pneumothorax is a rare finding. Furthermore, the mediastinitis after esophageal perforation is rare complication, but it can be a critical complication. Therefore, making an immediate and precise diagnosis as well as instituting proper treatment of esophageal perforation and mediastinitis are important. To the best of our knowledge, few reports have described mediastinitis after pneumomediastinum that was secondary to esophageal perforation. We describe here the radiologic findings of a rare case of mediastinitis after pneumomediastinum in a preterm infant with esophageal perforation. Index words : Esophagus, perforation Infants, newborn Mediastinitis Pneumomediastinum Pneumothorax Address reprint requests to : Ok Hwa Kim, M.D., Department of Diagnostic Radiology, Ajou University College of Medicine, Woncheon-dong, Youngtong-gu, Suwon , Korea. Tel Fax kimoh@ajou.ac.kr 535

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317 318 319 320 1 3 5 5 5 5 2 321 : 1.,,,,, 06 2. X-ray beam penetration (density) (contrast) 03 3. patch coating, precipitation, flaking 03 4. centering 03 5. Esophagus, cardia, fundus, body, angle, antrum,