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脓毒症后快速进展的心肌钙化

Rapidly progressive myocardial calcification following sepsis.

作者信息

Yoshihara Shu, Yaegashi Taku, Matsunaga Masaki, Naito Masaaki

机构信息

Department of Diagnostic Radiology, Iwata City Hospital, Iwata, Japan.

Department of Cardiology, Iwata City Hospital, Iwata, Japan.

出版信息

J Cardiol Cases. 2021 Sep 20;25(3):166-169. doi: 10.1016/j.jccase.2021.08.011. eCollection 2022 Mar.

Abstract

Sepsis is a clinical syndrome caused by a dysregulated host response to infection that can lead to multiple organ dysfunction and death. Cardiovascular abnormalities are frequent in sepsis and may result in myocardial injury unrelated to coronary artery disease. Myocardial calcification is a rare complication of sepsis, which shows rapid-onset extensive myocardial calcifications. We present a case of a 67-year-old man who developed severe sepsis complicated with shock, acute renal failure, and acute respiratory distress syndrome. Initial chest computed tomography (CT) on admission showed normal left ventricular (LV) myocardial attenuation. However, serial chest CT demonstrated a gradual increase of the LV myocardial attenuation, which ultimately resulted in extensive myocardial calcification within 6 weeks. Sepsis-related myocardial calcification is usually found in patients with severe sepsis complicated with hemodynamic failure requiring vasopressors, acute renal failure necessitating renal replacement therapy, and acute respiratory distress syndrome. Although the prognostic significance of this pathology is unclear, it may be a precursor to long-term irreversible cardiomyopathy or an arrhythmogenic substrate that induces life-threatening arrhythmias. Therefore, patients who have survived the acute phase of severe sepsis need to be monitored carefully for signs of this complication by an imaging modality such as CT. < Sepsis is common and may cause myocardial injury. Myocardial calcification is an uncommon complication of sepsis, usually found in patients with severe sepsis. Sepsis-related myocardial calcification is classified as dystrophic, and represents the sequelae of local tissue damage and cellular necrosis. With sepsis-related myocardial calcification, rapid-onset extensive myocardial calcifications can develop within the course of 1 to 3 months. Patients who have survived the acute phase of severe sepsis need to be monitored carefully for signs of this complication.>.

摘要

脓毒症是一种由宿主对感染的反应失调引起的临床综合征,可导致多器官功能障碍和死亡。心血管异常在脓毒症中很常见,可能导致与冠状动脉疾病无关的心肌损伤。心肌钙化是脓毒症的一种罕见并发症,表现为快速出现的广泛心肌钙化。我们报告一例67岁男性,他发生了严重脓毒症,并发休克、急性肾衰竭和急性呼吸窘迫综合征。入院时最初的胸部计算机断层扫描(CT)显示左心室(LV)心肌衰减正常。然而,系列胸部CT显示LV心肌衰减逐渐增加,最终在6周内导致广泛心肌钙化。脓毒症相关的心肌钙化通常见于患有严重脓毒症并发需要血管升压药的血流动力学衰竭、需要肾脏替代治疗的急性肾衰竭和急性呼吸窘迫综合征的患者。尽管这种病理改变的预后意义尚不清楚,但它可能是长期不可逆心肌病的先兆或诱发危及生命心律失常的致心律失常基质。因此,严重脓毒症急性期存活的患者需要通过CT等成像方式仔细监测这种并发症的迹象。<脓毒症很常见,可能导致心肌损伤。心肌钙化是脓毒症的一种不常见并发症,通常见于严重脓毒症患者。脓毒症相关的心肌钙化被归类为营养不良性钙化,代表局部组织损伤和细胞坏死的后遗症。对于脓毒症相关的心肌钙化,可在1至3个月内出现快速发生的广泛心肌钙化。严重脓毒症急性期存活的患者需要仔细监测这种并发症迹象。>

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