意識障害で発症したHamman症候群の1例

A case of Hamman’s syndrome presenting with consciousness disturbances

Hammanが1937年に糖尿病性昏睡と縦隔気腫を合併した若年性糖尿病患者を初めて報告して以降，糖尿病性ケトアシドーシスと縦隔気腫の合併はHamman症候群と呼ばれている^1）。一般に縦隔気腫が観察された場合，食道破裂や気管損傷など重篤な病態の合併に注意を要するが，本症候群では直接的な原因が存在せず保存的加療で軽快することが多い。今回，糖尿病性昏睡と縦隔気腫を合併したHamman症候群を経験したので文献的考察を加えて報告する。

A 15-year-old female was admitted for disturbance of consciousness. A blood examination, urinalysis and arterial blood gas analysis showed that she had been suffering from diabetic ketoacidosis. Chest X-ray films and computed tomography images revealed the presence of mediastinal emphysema. These findings supported a diagnosis of Hamman’s syndrome. Her diabetic ketoacidosis was managed with insulin and fluid therapy, and the mediastinal emphysema disappeared spontaneously. Hamman’s syndrome is a rare form of s mediastinal emphysema associated with diabetic ketoacidosis. Hamman’s syndrome is a benign condition and is treated conservatively. When we detect mediastinal emphysema in diabetic ketoacidosis, we should suspect Hamman’s syndrome.