Tasi F C, Fang J F, Lin P J, Chang Y S, Chang C H
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, R.O.C.
Changgeng Yi Xue Za Zhi. 1999 Dec;22(4):666-70.
We report the case of a 54-year-old male motorcyclist with an apparent grade IV liver injury and life-threatening hemomediastinum and right hemothorax following blunt deceleration trauma. Massive hemothorax and an unstable hemodynamic status even under copious blood volume replacement made emergent surgical intervention mandatory. A midline laparotomy was performed at first to rule out abdominal bleeding accompanied by a diaphragmatic tear, but the procedure was soon converted to a thoracotomy after finding an intact diaphragm and persistent bleeding from the chest tube. An isolated internal thoracic artery (ITA) transection was identified. It was actively bleeding and causing a huge anterior mediastinal hematoma and had ruptured into the right pleural cavity. The bleeder was controlled with suture ligation and the hemodynamic status was soon stabilized. The patient recovered without significant sequelae. The rarity of this kind of presentation is discussed, including both the ITA injury mechanism and the problems posed in making an early and correct diagnosis.
我们报告一例54岁男性摩托车手的病例，该患者在钝性减速创伤后出现明显的IV级肝损伤以及危及生命的纵隔积血和右侧血胸。即使在大量补液的情况下，大量血胸和不稳定的血流动力学状态也使得紧急手术干预成为必要。首先进行中线剖腹术以排除伴有膈肌撕裂的腹腔内出血，但在发现膈肌完整且胸管持续出血后，该手术很快转为开胸手术。发现一根孤立的胸廓内动脉（ITA）横断。它正在大量出血，导致巨大的前纵隔血肿，并已破裂进入右侧胸腔。通过缝合结扎控制了出血点，血流动力学状态很快稳定下来。患者康复，无明显后遗症。本文讨论了这种表现的罕见性，包括ITA损伤机制以及早期正确诊断所面临的问题。
