Lee Thung-Lip, Hsuan Chin-Feng, Shih Chen-Hsiang, Liang Huai-Wen, Tsai Hsing-Shan, Tseng Wei-Kung, Hsu Kwan-Lih
Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan.
Department of Internal Medicine, E-Da cancer hospital / I-Shou University, Kaohsiung, Taiwan.
BMC Cardiovasc Disord. 2017 Feb 10;17(1):56. doi: 10.1186/s12872-017-0496-3.
Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy.
Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting.
Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.
钝性心脏创伤涵盖多种临床情况，包括心肌挫伤、心脏破裂、瓣膜撕脱、心包损伤、心律失常，甚至心肌梗死。钝性胸部创伤后因冠状动脉夹层导致的急性心肌梗死较为罕见，且可能危及生命。在此情况下，急性心肌梗死与心脏挫伤的鉴别诊断并不容易。
我们在此展示一例钝性胸部创伤病例，在急诊科早期通过计算机断层扫描检测到心肌强化缺损。在急性心肌梗死的诊断印象下，紧急冠状动脉造影显示左前降支动脉闭塞。进行了血运重建，血栓抽吸后发现冠状动脉夹层。最终，患者在冠状动脉支架置入术后存活。
钝性胸部创伤后CT上心肌强化的灌注缺损对于提示心肌梗死以及促进紧急手术的决策非常有帮助。在初步解读时不应错过这一有价值的征象。
