Yip Michael F, Walsh Brooks M
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
Department of Emergency Medicine, Bridgeport Hospital, Bridgeport, Connecticut.
J Emerg Med. 2017 Apr;52(4):e105-e109. doi: 10.1016/j.jemermed.2016.10.023. Epub 2017 Jan 20.
The differential diagnosis for chest pain in the emergency department is broad and includes both benign and life-threatening conditions-with pericardial cyst as a rare example. Emergency physician-performed point-of-care focused cardiac ultrasound (FOCUS) is increasingly recognized as a useful modality in the evaluation of patients with chest pain.
We report a case of hemorrhagic pericardial cyst in a young woman presenting with chest pain in which findings on FOCUS contradicted findings on chest x-ray study and thus, accelerated diagnosis and definitive treatment. We also comment on epidemiology, pathophysiology, clinical presentation, diagnosis, and management of this uncommon, potentially fatal cause of chest pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report aims to bring an uncommon case to the attention of emergency providers and emphasize the importance of facility with FOCUS. Although definitive diagnosis and management were not accomplished at the bedside in this case, an abnormal finding on FOCUS prompted further investigation and timely treatment.
急诊科胸痛的鉴别诊断范围广泛，包括良性和危及生命的情况，心包囊肿就是一个罕见的例子。急诊医生进行的床旁重点心脏超声检查（FOCUS）在评估胸痛患者时越来越被认为是一种有用的检查方法。
我们报告了一例年轻女性出血性心包囊肿病例，该患者因胸痛就诊，FOCUS检查结果与胸部X线检查结果相矛盾，从而加速了诊断和明确治疗。我们还对这种不常见的、可能致命的胸痛原因的流行病学、病理生理学、临床表现、诊断和治疗进行了评论。为什么急诊医生应该了解这个病例？：本病例报告旨在引起急诊医疗人员对这一罕见病例的关注，并强调掌握FOCUS检查的重要性。虽然本病例在床边未完成明确诊断和治疗，但FOCUS检查的异常发现促使进一步检查和及时治疗。
