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创伤性胸骨后血肿导致心包外心脏压塞——病例报告

Traumatic retrosternal hematoma leading to extra-pericardial cardiac tamponade-Case report.

作者信息

Arabi Rami Issam, Aljudaibi Abdullah, Althumali Abdullah Abdulaziz, Rajb Badr Saeed, Arja Rawad Daniel

机构信息

Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia.

King Abdulaziz Hospital, General surgery Jeddah, Saudi Arabia.

出版信息

Int J Surg Case Rep. 2019;61:30-32. doi: 10.1016/j.ijscr.2019.06.055. Epub 2019 Jun 27.

Abstract

INTRODUCTION

Cardiac tamponade typically results from fluid or gas collection in the pericardial space leading to impairment in the cardiac function.

PRESENTATION OF CASE

A 34 years old male patient presented to the ER after a fall from height. X-rays were done which showed no hemothorax or pneumothorax and multiple stable pelvic fractures. Computed tomography (CT) scan for trauma was done after stabilizing the patient and showed sternal fracture with a huge retrosternal hematoma. The patient was intubated immediately, and an Echocardiogram was ordered along with preparation to go to the operation room urgently due to high suspicion of a rare case of cardiac tamponade. but the patient had cardiac arrest and couldn't be revived despite the CPR effort.

DISCUSSION

This is a very unusual presentation of cardiac tamponade, mediastinal hematoma leading to extra pericardial tamponade. CT scan is an effective method to diagnose extra pericardial tamponade. In addition, to the high clinical suspicion is required. The sole treatment of mediastinal hematoma is an urgent evacuation.

CONCLUSION

A careful assessment with high clinical suspicion along with CT Scan is the best way to diagnose extra pericardial tamponade cause by sternal fracture.

摘要

引言

心脏压塞通常是由于心包腔内积液或积气导致心脏功能受损。

病例介绍

一名34岁男性患者从高处坠落后来到急诊室。X线检查显示无血胸或气胸,以及多处稳定的骨盆骨折。在患者病情稳定后进行了创伤计算机断层扫描(CT),结果显示胸骨骨折并伴有巨大的胸骨后血肿。患者立即被插管,并因高度怀疑罕见的心脏压塞病例而在准备紧急送往手术室的同时进行了超声心动图检查。但患者发生心脏骤停,尽管进行了心肺复苏努力仍未能复苏。

讨论

这是心脏压塞的一种非常不寻常的表现,纵隔血肿导致心包外压塞。CT扫描是诊断心包外压塞的有效方法。此外,还需要高度的临床怀疑。纵隔血肿的唯一治疗方法是紧急引流。

结论

通过高度的临床怀疑进行仔细评估并结合CT扫描是诊断胸骨骨折所致心包外压塞的最佳方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c471/6627002/3a1394026e5b/gr1.jpg

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