Felder Seth I
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Trauma Case Rep. 2015 Apr 14;1(1-2):4-8. doi: 10.1016/j.tcr.2015.02.002. eCollection 2015 Feb.
Disseminated cocciodiomycosis with extrapulmonary disease occurs in less than 1% of infected patients, with few cases involving the pericardium reported in the literature. A subxiphoid window in a focussed assessment with sonography for trauma is a fast and reliable study for detecting haemopericardium in the haemodynamically unstable injured patient.
Case report and literature review.
A 50-year old man presented in extremis following a stab wound to the right thoracoabdominal region with a positive pericardial ultrasound. At the time of emergent sternotomy, the pericardial effusion appeared non-traumatic and not the cause of haemodynamic instability. Lung, diaphragm, liver and transverse colon lacerations were controlled by laparotomy. He was discovered to have extensive adenopathy within the mediastinum, porta hepatis, and lesser sac, which after histopathologic examination, demonstrated granulomatous lymphadenitis consistent with disseminated cocciodiomycosis.
This case report describes the first reported "incidental" pericardial effusion in a haemodynamically unstable patient sustaining a thoracoabdominal stab wound discovered on a positive ultrasound study. Emergent operative exploration and subsequent workup determined the pericardial fluid to be of infectious origin, rather than traumatic. With the incidence of cocciodiomycosis within endemic geographic regions significantly rising, coccidioidal pericarditis may become an increasingly relevant cause of fluid detected on noninvasive pericardial examination.
播散性球孢子菌病合并肺外疾病在不到1%的感染患者中发生，文献报道累及心包的病例很少。在创伤重点超声评估中使用剑突下视窗对血流动力学不稳定的受伤患者进行检测心包积血是一种快速且可靠的检查方法。
病例报告及文献回顾。
一名50岁男性在右胸腹区域被刺伤后情况危急，心包超声检查呈阳性。在紧急开胸手术时，心包积液看似并非由创伤引起，也不是血流动力学不稳定的原因。通过剖腹手术控制了肺、膈肌、肝脏和横结肠的裂伤。发现他在纵隔、肝门和网膜囊内有广泛的淋巴结肿大，经组织病理学检查，显示为符合播散性球孢子菌病的肉芽肿性淋巴结炎。
本病例报告描述了首例在血流动力学不稳定的胸腹刺伤患者中，经超声检查呈阳性发现的“意外”心包积液。紧急手术探查及后续检查确定心包积液为感染性而非创伤性。随着球孢子菌病在流行地区的发病率显著上升，球孢子菌性心包炎可能成为无创心包检查中发现的积液越来越常见的原因。
