Souteyrand Geraud, Combes Stéphane, Dauphin Claire, Geoffroy Etienne, Motreff Pascal, Joly Hervé, Cassagnes Jean, Lusson Jean René
CHU Clermont-Ferrand, service de cardiologie Pr. CASSAGNES, rue Montalembert, 63000 Clermont Ferrand, France.
Eur J Echocardiogr. 2008 Jan;9(1):116-8. doi: 10.1016/j.euje.2007.03.046.
Occult cardiac injury following blunt trauma is more common than generally suspected. Myocardial contusion is not rare, however, it is generally a benign disorder which often remains undiagnosed. We report a case of a right atrial rupture after blunt chest trauma causing a tamponade. A 24-year-old man was involved in a violent car accident and he presented in a state of collapse. A multislice computed tomography indicated a pericardial effusion (Figure 1). A transthoracic echocardiography was performed and confirmed pericardial effusion which was hyperechoic (Figure 2, Movie 1). Concerns about a possible mass in the right atrium led to examination with transesophageal echocardiography (Figure 3, Movie 2) which revealed the presence of a voluminous mass in the right atrium. The patient successfully underwent cardiac surgery to remove the mass, identified as a blood clot, and to repair the atrial tear. The present case is of special interest because of the rarity of documented incidents of blunt chest trauma causing right atrial tear and illustrates the usefulness of transesophageal echocardiography in completing the diagnosis in the event of haemopericardium.
钝性创伤后隐匿性心脏损伤比一般认为的更为常见。心肌挫伤并不罕见，然而，它通常是一种良性疾病，常常未被诊断出来。我们报告一例钝性胸部创伤后右心房破裂导致心包填塞的病例。一名24岁男性遭遇严重车祸，就诊时处于昏迷状态。多层计算机断层扫描显示有心包积液（图1）。进行了经胸超声心动图检查，证实存在高回声心包积液（图2，视频1）。由于担心右心房可能存在肿块，遂进行经食管超声心动图检查（图3，视频2），结果显示右心房有一个巨大肿块。患者成功接受了心脏手术，切除了被确认为血凝块的肿块，并修复了心房撕裂处。本病例特别引人关注，因为钝性胸部创伤导致右心房撕裂的记录事件很少见，并且说明了经食管超声心动图在血心包情况下完成诊断的有用性。
