钝性心脏和心包损伤合并出现大量血胸而无心包积血。
Combination of blunt cardiac and pericardial injury presenting a massive hemothorax without hemopericardium.
作者信息
Kittaka Hirotada, Yagi Yoshiki, Zushi Ryosuke, Hazui Hiroshi, Akimoto Hiroshi
机构信息
Department of Emergency Osaka Mishima Emergency Critical Care Center Takatsuki City Japan.
出版信息
Acute Med Surg. 2015 Apr 27;2(4):257-259. doi: 10.1002/ams2.112. eCollection 2015 Oct.
CASE
A 64-year-old man was injured after falling from a height of 5 m and was transported to our institution. On presentation, his hemodynamic state was unstable, and both focused assessment with sonography for trauma and enhanced computed tomography imaging revealed massive left pleural effusion, but no pericardial effusion. He went into cardiopulmonary arrest just before surgery, so an urgent left anterolateral thoracotomy followed by open chest cardiac massage and aortic clamping were carried out. By performing an additional right anterior thoracotomy, a left pleuropericardial laceration and a perforation measuring 1 cm in diameter at the left ventricle were found. The patient's dynamic state stabilized following the restoration of hemostasis by suturing the rupture site.
OUTCOME
The patient's postoperative course was favorable, and he was discharged after 20 days of hospitalization.
CONCLUSION
Blunt cardiac and pericardial injury rarely causes massive hemothorax with no hemopericardium, resulting in hemorrhagic shock.
病例
一名64岁男性从5米高处坠落受伤后被送至我院。入院时，他的血流动力学状态不稳定，创伤超声重点评估和增强计算机断层扫描成像均显示大量左侧胸腔积液，但无心包积液。他在手术前心跳骤停，因此紧急进行了左前外侧开胸术，随后进行了开胸心脏按压和主动脉钳夹。通过额外进行右前开胸术，发现左胸膜心包撕裂和左心室直径1厘米的穿孔。通过缝合破裂部位止血后，患者的动态状态稳定。
结果
患者术后恢复良好，住院20天后出院。
结论
钝性心脏和心包损伤很少导致大量血胸而无心包积血，从而引起失血性休克。
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