Campbell Catherine Y, Record Janet D, Kolandaivelu Aravindan, Ziegelstein Roy C
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Gen Intern Med. 2006 Jun;21(6):C7-10. doi: 10.1111/j.1525-1497.2006.00400.x.
A 32-year-old man was elbowed in the chest while fighting for a rebound in a recreational basketball game. He fell to the ground and his chest ached from the blow. Four days later he developed more severe chest pressure with dyspnea and came to the hospital. His chest wall was tender and his pulse slow, but the remainder of his physical examination was normal. Electrocardiogram showed sinus bradycardia, first-degree atrioventricular (AV) block, and occasional isorhythmic AV dissociation, but no ischemic ST-T changes. Cardiac troponin I rose to 1.74 ng/mL (normal <0.50). The patient therefore underwent coronary angiography, showing spiral dissection of the right coronary artery with extensive thrombus filling the distal portion of the vessel. Stenting was unsuccessful in restoring flow. This case highlights the potential dangers of blunt chest trauma in recreational sports and shows how angiography can distinguish myocardial contusion from coronary artery dissection.
一名32岁男性在一场业余篮球比赛中争抢篮板球时胸部被肘部击中。他摔倒在地，胸部因撞击而疼痛。四天后，他出现了更严重的胸痛伴呼吸困难，遂前来医院就诊。他的胸壁压痛，脉搏缓慢，但其余体格检查正常。心电图显示窦性心动过缓、一度房室传导阻滞，偶尔出现等律性房室分离，但无缺血性ST-T改变。心肌肌钙蛋白I升至1.74 ng/mL（正常<0.50）。因此，该患者接受了冠状动脉造影，显示右冠状动脉螺旋状夹层，远端血管有大量血栓形成。支架置入未能恢复血流。该病例突出了业余体育运动中钝性胸部创伤的潜在危险，并展示了血管造影如何区分心肌挫伤和冠状动脉夹层。
