气肿性椎体骨髓炎
A 62-year-old man presented to the emergency department with a 5-day history of low back pain and a 1-day history of lethargy.
一名62岁男性患者因腰痛5天伴嗜睡1天就诊于急诊科。。
Physical examination was notable for tenderness over the lumbar spine and a normal neurologic examination. Radiographs of the lumbar spine showed gas within L4 (Panel A, arrow). Computed tomography of the lumbar spine confirmed the presence of intramedullary gas within L4 — a finding known as the pumice stone sign — and also showed that the gas extended into the surrounding soft tissue, epidural space, and psoas muscles (Panel B). Magnetic resonance imaging of the lumbar spine showed the intramedullary gas, as well as a gas-containing epidural abscess that was causing mild compression of the cauda equina (Panel C, arrow). Cultures of blood, sputum, and urine grew extended-spectrum β-lactamase–producing Klebsiella pneumoniae.
体格检查腰椎压痛，神经系统检查正常。腰椎X线示L4椎体内存在气体（图A，箭头所示）。腰椎CT证实L4椎体内存在椎体内气体（浮石征）同时显示气体已延伸至周围软组织、硬膜外腔及腰大肌（图B）。腰椎MRI示椎体内气体，以及一个含气性硬膜外脓肿，该脓肿导致马尾轻度受压（图C，箭头所示）。血液、痰液及尿液培养结果显示为产超广谱β-内酰胺酶肺炎克雷伯菌。
A diagnosis of emphysematous vertebral osteomyelitis and epidural abscess due to disseminated klebsiella infection was made. Although surgery is the standard treatment for this type of infection, a multidisciplinary team recommended medical management for this patient owing to his critical illness, the stability of his spine, and the absence of neurologic deficits. The patient received an extended course of antibacterial agents. At a 3-month follow-up visit, he was doing well.
诊断为播散性克雷伯菌感染所致的气肿性椎体骨髓炎及硬膜外脓肿。尽管手术是标准治疗方式，但由于患者病情危重、脊柱稳定性良好且无神经功能缺损，多学科团队建议采用药物治疗。患者接受了延长疗程的抗菌药物治疗。在3个月随访时，其病情稳定。
医学词汇：
1.lthargy：嗜睡，英[ˈleθədʒi]。源自古希腊语lēthargia（由lēthē（遗忘）+argos（懒散）复合而成）
2.lumbar spine：腰椎，英[ˈlʌmbə spaɪn]。
3.neurologic：神经学的，英[njʊəˈrɒlədʒɪk] 。Neurology（神经学），Neuropathy（神经病变），Neurological Exam（神经科检查）
4.intramedullary：髓内的（脊髓或骨髓内，英[ˌɪntrəˈmedələri] 。解释时候需要结合上下文，通常指脊髓内的。Intramedullary Tumor（髓内肿瘤），Intramedullary Hemorrhage（髓内出血）
5.epidural：硬膜外的，英[ˌepɪˈdjʊərəl] 。Epidural Anesthesia（硬膜外麻醉）。
6.psoas muscles：腰肌，由腰大肌（psoas major）和腰小肌（psoas minor）组成。
7.cauda equina：马尾神经，英[ˈkɔːdə ˈekwɪnə] 。Cauda Equina Syndrome（马尾综合征）。
8.sputum：痰液，英[ˈspjuːtəm]。
9.extended-spectrum：广谱的。
10.emphysematous vertebral osteomyelitis：emphysematous（气肿的，+vertebral（椎体的）+osteomyelitis（骨髓炎，由osteo-（骨）+myelo-（髓）+-itis（炎症）组成）
11.disseminated：播散性的，英[dɪˈsemɪneɪtɪd]。通常在感染性病变中出现，Disseminated Infection（播散性感染），Disseminated Intravascular Coagulation（DIC）（弥散性血管内凝血）
拓展阅读：
浮石征：
浮石是什么样的？
气肿性骨髓炎还可以发生在其他部位，如髂骨。
气肿性感染，还可以发生其他器官，如气肿性膀胱炎、气肿性肝炎、气肿性胆囊炎、气肿性肾盂肾炎、气肿性胃炎等
气肿性膀胱炎
气肿性肾盂肾炎
气肿性胆囊炎
气肿性胃炎
气肿性肝炎，破坏了肝静脉造成气体进入肺动脉