Ogura Hiroki, Kimata Ryutaro, Mitta Shohei, Umeda Etsuji, Ishida Narihiro, Shimabukuro Katsuya, Nakashima Takashi, Kanamori Hiromitsu, Kawasaki Masanori, Doi Kiyoshi
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Gifu, 501-1194, Japan.
Gen Thorac Cardiovasc Surg. 2020 Apr;68(4):392-395. doi: 10.1007/s11748-019-01124-4. Epub 2019 Apr 9.
Hemorrhagic pericardial effusion is life-threatening and mostly occurs during pericarditis; however, its underlying mechanism is unclear. We report a case of pericardial hematoma with obvious hemorrhage. A 56-year-old man without prior chest trauma presenting with exertional dyspnea and abdominal fullness was treated for idiopathic pericarditis. The echocardiogram showed a thickened pericardium with effusion. Imaging showed extravasation and neovascularization. Following ineffective pharmacotherapy, we performed pericardiectomy. The site of bleeding was undetectable. Because parietal pericardiectomy with hematoma evacuation did not improve diastolic function, we removed the epicardium. During the follow-up period, the patient remained almost asymptomatic. We identified neovascularization as the potential source of idiopathic pericardial hemorrhage.
出血性心包积液危及生命，多发生于心包炎期间；然而，其潜在机制尚不清楚。我们报告一例伴有明显出血的心包血肿病例。一名56岁无既往胸部外伤史的男性，因劳力性呼吸困难和腹部胀满就诊，被诊断为特发性心包炎。超声心动图显示心包增厚并伴有积液。影像学检查显示有外渗和新生血管形成。药物治疗无效后，我们进行了心包切除术。出血部位无法检测到。由于行心包壁层切除术并清除血肿后舒张功能未改善，我们切除了心外膜。在随访期间，患者几乎无症状。我们确定新生血管形成是特发性心包出血的潜在来源。
