Jedidi Maher, Tilouche Samia, Masmoudi Tasnim, Sahnoun Maha, Chkirbène Youssef, Mestiri Sarra, Boughamoura Lamia, Ben Dhiab Mohamed, Souguir Mohamed Kamel
Department of Legal Medicine - Farhat Hached University Hospital, Sousse - Tunisia .
Department of Pediatrics - Farhat Hached University Hospital, Sousse - Tunisia .
Autops Case Rep. 2016 Dec 30;6(4):15-19. doi: 10.4322/acr.2016.052. eCollection 2016 Oct-Dec.
Myocarditis is an inflammatory disease of the myocardium with heterogeneous clinical manifestations and progression. In clinical practice, although there are many methods of diagnosis of acute myocarditis, the diagnosis remains an embarrassing dilemma for clinicians. The authors report the case of 9-month-old infant who was brought to the Pediatric Emergency Department with sudden onset dyspnea. Examination disclosed heart failure and resuscitation was undertaken. The electrocardiogram showed an ST segment elevation in the anterolateral leads with a mirror image. Cardiac enzyme tests revealed a significant elevation of troponin and creatine phosphokinase levels. A diagnosis of acute myocardial infarction was made, and heparin therapy was prescribed. The infant died on the third day after admission with cardiogenic shock. The autopsy showed dilatation of the ventricles and massive edema of the lungs. Histological examinations of myocardium samples revealed the presence of a marked lymphocytic infiltrate dissociating myocardiocytes. Death was attributed to acute myocarditis. The authors call attention to the difficulties of differential diagnosis between acute myocarditis and acute myocardial infarction especially in children, and to the important therapeutic implications of a correct diagnosis.
心肌炎是一种心肌的炎症性疾病，临床表现和病程各异。在临床实践中，虽然有多种诊断急性心肌炎的方法，但对临床医生来说，诊断仍然是一个棘手的难题。作者报告了一例9个月大的婴儿，该婴儿因突发呼吸困难被送往儿科急诊科。检查发现心力衰竭并进行了复苏。心电图显示前外侧导联ST段抬高并有镜像改变。心肌酶检测显示肌钙蛋白和肌酸磷酸激酶水平显著升高。诊断为急性心肌梗死，并给予肝素治疗。婴儿在入院第三天死于心源性休克。尸检显示心室扩张和肺部大量水肿。心肌样本的组织学检查显示存在明显的淋巴细胞浸润，使心肌细胞分离。死亡原因是急性心肌炎。作者提醒注意急性心肌炎与急性心肌梗死鉴别诊断的困难，尤其是在儿童中，以及正确诊断的重要治疗意义。
