Suksompong Sirilak, von Bormann Benno
Department of Anesthesiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok 10700, Thailand.
Case Rep Emerg Med. 2014;2014:758935. doi: 10.1155/2014/758935. Epub 2014 Nov 18.
We report a case of thoracic aortic rupture after blunt trauma in a 23-year-old male patient. The initial investigation found no external injury or bleeding, only a slightly widened mediastinum and a broken left calcaneus. Abdominal lavage was negative, biochemistry was normal, and breathing and oxygenation were not compromised. When changing his position during diagnostics, the patient all of a sudden developed cardiac arrest and typical signs of hypovolemic shock. An immediate sternotomy was done without any further diagnostics on suspicion of aortic isthmus injury. A circular avulsion at the ligamentum arteriosum was found as assumed and repaired under cardiopulmonary bypass. The patient left the hospital for rehabilitation after 12 days in adequate health status. Biodynamics of blunt trauma after high-speed frontal impact and the relationship between calcaneus fracture, called "Don-Juan fracture," and aortic rupture at the site of ligamentum arteriosum are discussed.
我们报告一例23岁男性患者钝性创伤后胸主动脉破裂的病例。初步检查未发现外部损伤或出血，仅纵隔轻度增宽和左跟骨骨折。腹腔灌洗结果为阴性，生化指标正常，呼吸和氧合未受影响。在诊断过程中改变患者体位时，患者突然发生心脏骤停和典型的低血容量性休克体征。因怀疑主动脉峡部损伤，未进行进一步诊断即立即行胸骨切开术。如预期那样，发现动脉韧带处有环形撕脱，并在体外循环下进行了修复。患者在健康状况良好的情况下于12天后出院进行康复治疗。本文讨论了高速正面撞击后钝性创伤的生物力学以及被称为“唐璜骨折”的跟骨骨折与动脉韧带处主动脉破裂之间的关系。
