Wijeyaratne S M, Weerasinghe C, Cassim M R N
Department of Surgery, University of Colombo, Colombo, Sri Lanka.
BMJ Case Rep. 2010 Jul 21;2010:bcr0120102677. doi: 10.1136/bcr.01.2010.2677.
Unattended blunt carotid injury (BCI) has stroke high risk of stroke and screening based on injury probability is recommended. Penetrating forces are not considered high risk and concomitant BCI would go unattended. The authors report a case of a 48-year-old man who fell out of a tree on to an upright stick that penetrated his lateral neck. He presented with impalement, which was removed after surgically laying open the entire wound. The carotid sheath had been breached and the internal jugular vein was bleeding. The adjacent common carotid artery was intact and pulsating with no external evidence of injury. However, injury proximity led to vascular imaging that demonstrated intimal disruption without thrombus or stenosis. Although he remained asymptomatic on heparin, the injury progressed to cause significant lumen stenosis. Endovascular stenting re-established the vessel lumen and he remains well on aspirin 9 months later. Awareness that penetrating neck trauma may cause BCIs is important.
无症状钝性颈动脉损伤(BCI)具有较高的中风风险,建议根据损伤概率进行筛查。穿透性损伤不被视为高风险,同时存在的BCI可能会被漏诊。作者报告了一例48岁男性病例,该患者从树上跌落至一根直立的木棍上,木棍穿透其侧颈部。他表现为刺入伤,手术切开整个伤口后取出了木棍。颈动脉鞘已被穿透,颈内静脉出血。相邻的颈总动脉完整且有搏动,无外部损伤迹象。然而,由于损伤部位临近,血管成像显示内膜破裂但无血栓或狭窄。尽管他在使用肝素期间无症状,但损伤仍进展导致管腔明显狭窄。血管内支架置入术重新建立了血管管腔,9个月后他服用阿司匹林情况良好。认识到穿透性颈部创伤可能导致BCI很重要。