Yamada Hiroshi, Sakurai Asako, Higurashi Aya, Takeda Kohji
Critical Care Division, Fujisawa City Hospital, Fujisawa, Kanagawa, Japan.
Department of Anesthesiology, Fujisawa City Hospital, Fujisawa, Kanagawa, Japan.
BMJ Case Rep. 2015 Jan 27;2015:bcr2014207352. doi: 10.1136/bcr-2014-207352.
A 71-year-old woman presented at our hospital with chest discomfort. Cardiac CT showed an impending double rupture; an intraseptal pseudoaneurysm had ruptured into the right ventricle, while the left ventricular free wall remained intact at this stage. After admission, the patient fell into cardiogenic shock. Emergency surgery was performed. The intraoperative findings included a double rupture of the ventricular septum and the left ventricular free wall. Double rupture is a rare but fatal complication of myocardial infarction. Early diagnosis is essential. Recently, cardiac CT has emerged as a valuable tool for patients with possible ischaemic disease. In this case, enhanced cardiac CT showed an impending double rupture of junctional-type. The static and dynamic images of intraseptal pseudoaneurysm by two-dimensional (2-D) CT, 3-D CT and 4-D CT presented here provide insights into the mechanisms behind, and the pathophysiology of, double ruptures. They also demonstrate the significance of cardiac CT for evaluating ischaemic heart disease.
一名71岁女性因胸部不适前来我院就诊。心脏CT显示即将发生双破裂；室间隔假性动脉瘤已破裂入右心室，而此时左心室游离壁保持完整。入院后，患者陷入心源性休克。遂进行了急诊手术。术中发现室间隔和左心室游离壁双破裂。双破裂是心肌梗死罕见但致命的并发症。早期诊断至关重要。近年来，心脏CT已成为诊断可能患有缺血性疾病患者的重要工具。在本病例中，增强心脏CT显示为交界型即将发生双破裂。本文展示的二维（2-D）CT、三维CT和四维CT对室间隔假性动脉瘤的静态和动态图像，为双破裂背后的机制和病理生理学提供了见解。它们还证明了心脏CT在评估缺血性心脏病方面的重要性。
