압축공기에 의한 수상으로 안와기종과 뇌기종이 발생한 1예
Orbital Emphysema and Pneumocephalus Caused by Compressed Air Injury
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목적: 압축공기에 수상 후 안와기종, 뇌기종이 발생한 환자 1예를 보고하고자 한다. 증례요약: 49세 남자가 작업 중 에어건에서 송출되는 압축공기에 좌안을 수상하여 내원하였다. 좌측 안와주위부종, 상하안검의 염발음, 압통이 있었다. 세극등현미경검사에서 12 mm의 외측 결막열상, 결막하출혈, 결막하 공기방울이 관찰되었고 전방출혈 소견이 있었다. 안와와 두부 전산화단층촬영에서 피하 및 안와기종이 관찰되었으며, 뇌기종이 관찰되었다. 결막열상에 대한 일차봉합술을 시행하였고, 입원 후 정맥 내 항생제 투여와 절대 안정을 취하고 항생제 안약을 점안하였다. 외상 4일 후 안검부종 및 전방출혈은 감소하였고, 외상 후 6일째 시행한 전산화단층촬영에서 뇌기종과 안와기종은 현저히 감소하였다. 압축공기에 의한 수상으로 안와골절 없이 안와기종과 뇌기종이 발생한 경우는 매우 드물게 보고되고 있으며 이에 본 증례를 보고하는 바이다. 결론: 압축공기에 안와수상 시 안와골절의 발생 없이 안와기종, 뇌기종이 발생할 수 있다.
Abstract
Purpose: To report a case of orbital emphysema and pneumocephalus after exposure to compressed air. Case summary: A 49-year-old male visited our medical center after his left eye was damaged by a compressed air gun in an industrial setting. During the anterior segment examination, swelling of the left periorbital area, crepitation, and tenderness were observed in the upper and lower eyelids. On slit-lamp examination, there was a 12 mm conjunctival laceration in the temporal area, subconjunctival hemorrhage, multiple subconjunctival air bubbles, and microhyphema in the anterior chamber. A computed tomography scan of the head and orbit showed subcutaneous and intraorbital emphysema and pneumocephalus. Primary closure of the lacerated conjunctiva was performed. The patient was prescribed systemic and topical antibiotics with bed rest. Four days after the trauma, microhyphema and swelling of the eyelids were decreased significantly. Six days after the trauma, there were improvements of orbital emphysema and pneumocephalus without any complications. In summary, we report a rare case of orbital emphysema and pneumocephalus caused by compressed air. Conclusions: Orbital emphysema and pneumocephalus can occur due to compressed air injury in the absence of orbital wall fracture.
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