穿透性胸部损伤中创伤性室间隔穿孔的延迟诊断：CT显示室间隔血肿形成提示穿孔。
Delayed diagnosis of traumatic ventricular septal perforation in penetrating chest injury: hematoma formation in the ventricular septum in CT suggests perforation.
作者信息
Shioya Nobuki, Inoue Nozomu, Muto Harutatsu, Tomita Akiko, Tsukamoto Yuki, Kawashima Naonori, Hazama Koji, Shichinohe Yasuo
机构信息
Critical Care and Emergency Center National Hospital Organization Hokkaido Medical Center Nishi-Ku Sapporo Japan.
Department of Cardiology National Hospital Organization Hokkaido Medical Center Nishi-Ku Sapporo Japan.
出版信息
Acute Med Surg. 2019 Apr 25;6(3):321-324. doi: 10.1002/ams2.419. eCollection 2019 Jul.
BACKGROUND
Ventricular septal perforation (VSP) can be caused by a penetrating cardiac injury. Diagnosis of VSP tends to be delayed because a shunt might not be detected by color flow Doppler at an early stage following injury.
CASE PRESENTATION
A 60-year-old man with depression was admitted to the emergency center after a knife injury in the chest. A focused assessment with sonography for trauma revealed cardiac tamponade. Shortly after an open cardiac massage and a pericardiotomy, his spontaneous circulation returned. At a later stage, follow-up computed tomography, echocardiography, and left ventriculography showed traumatic ventricular septal perforation. Conservative therapy was chosen because the pulmonary blood flow/systemic blood flow ratio was 1.42.
CONCLUSION
The initial contrast computed tomography shows a septal hematoma. Its presence could be perceived as a perforation site in the interventricular septum.
背景
室间隔穿孔（VSP）可由穿透性心脏损伤引起。VSP的诊断往往会延迟，因为在损伤后的早期阶段，彩色多普勒可能无法检测到分流。
病例介绍
一名60岁患有抑郁症的男性在胸部被刀刺伤后被送往急诊中心。创伤超声重点评估显示心包填塞。在进行开胸心脏按摩和心包切开术后不久，他恢复了自主循环。在后期，后续的计算机断层扫描、超声心动图和左心室造影显示为创伤性室间隔穿孔。由于肺血流量/体循环血流量比值为1.42，因此选择了保守治疗。
结论
最初的增强计算机断层扫描显示有间隔血肿。其存在可被视为室间隔的穿孔部位。
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