Takeda Shinichi, Yonezawa Masato, Shirasawa Kunimasa, Hatakeyama Yuko, Sasaki Yoshio, Inenaga Katsura, Takeoka Rei, Doi Tetsuya, Hwang Myung Woo, Kawai Chuichi
Int J Cardiol. 2007 Jan 31;115(1):e20-1. doi: 10.1016/j.ijcard.2006.07.081. Epub 2006 Oct 12.
A 71-year-old man visited our hospital complaining of increasing fatigue and exertional dyspnea. He had had severe epigastric pain for the past 5 months. On admission, chest radiogram showed marked cardiac dilatation and echocardiogram massive pericardial effusion with a small subepicardial aneurysm at the posterior wall of the left ventricle. An urgent pericardiocentesis removed 1300 ml of bloody effusion. The red blood cell count of the pericardial effusion was similar to that of the peripheral blood, and there were no abnormal findings on cytologic and bacteriological examinations. Coronary angiography showed a blunt occlusion of the mid-portion of the circumflex artery. Left ventricular angiogram revealed aneurysmal deformity of the left ventricular posterior wall. These findings suggested that an oozing type of left ventricular rupture via a subepicardial aneurysm had occurred after the onset of myocardial infarction (MI), resulting in massive accumulation of pericardial effusion. The patient is presently doing well without any clinical symptoms 18 months after pericardiocentesis. This is the first case report in which a subepicardial aneurysm with massive pericardial effusion was detected in the chronic stage of MI and successfully managed without surgical repair.
一名71岁男性因疲劳加重和劳力性呼吸困难前来我院就诊。他在过去5个月里一直患有严重的上腹部疼痛。入院时，胸部X线片显示心脏明显扩大，超声心动图显示大量心包积液，左心室后壁有一个小的心外膜下动脉瘤。紧急心包穿刺抽出1300毫升血性积液。心包积液的红细胞计数与外周血相似，细胞学和细菌学检查未发现异常。冠状动脉造影显示回旋支动脉中段钝性闭塞。左心室造影显示左心室后壁呈瘤样畸形。这些发现提示心肌梗死（MI）发作后，通过心外膜下动脉瘤发生了渗出型左心室破裂，导致心包积液大量积聚。心包穿刺18个月后，患者目前情况良好，无任何临床症状。这是首例在MI慢性期检测到伴有大量心包积液的心外膜下动脉瘤且未经手术修复而成功治疗的病例报告。
