Nagy K K, Gilkey S H, Roberts R R, Fildes J J, Barrett J
Department of Trauma, Cook County Hospital, Chicago, IL, USA.
Acad Emerg Med. 1996 Nov;3(11):1024-7. doi: 10.1111/j.1553-2712.1996.tb03347.x.
To determine the accuracy of CT of the chest in diagnosing the presence of cardiac injury in stable patients with penetrating chest injuries.
A retrospective chart review of a convenience sample of stable patients with penetrating thoracic wounds evaluated for hemopericardium using chest CT at an urban level I trauma center.
60 stable patients with penetrating wounds in proximity to the heart underwent CT. Three patients had radiographic evidence of pericardial fluid, and 1 had an equivocal study. These 4 patients underwent subxiphoid pericardial window exploration: 2 had only clear fluid present, the other 2 had hemopericardium. The latter patients had a total of 3 cardiac and 1 diaphragmatic injuries, which were repaired at subsequent sternotomy. None of the 56 patients who had negative CTs had further clinical evidence of cardiac injury. The sensitivity, specificity, and accuracy of CT in this setting for hemopericardium are 100% (95% CI 18-100%), 96.6% (95% CI 88-100%), and 96.7% (95% CI 89-100%), respectively.
Chest CT may be a useful test for diagnosing the presence of hemopericardium in the setting of penetrating thoracic injury. With the caveat that the patient must be removed from a closely monitored environment, the authors the use of CT in stable patients with penetrating chest wounds whenever echocardiography is unavailable.
确定胸部CT在诊断稳定型穿透性胸部损伤患者心脏损伤方面的准确性。
对一家城市一级创伤中心使用胸部CT评估心包积血的稳定型穿透性胸部创伤患者的便利样本进行回顾性病历审查。
60例心脏附近有穿透伤的稳定患者接受了CT检查。3例患者有影像学证据显示心包积液，1例检查结果不明确。这4例患者接受了剑突下心包开窗探查：2例仅见清亮液体，另外2例有心包积血。后2例患者共有3处心脏损伤和1处膈肌损伤，在随后的胸骨切开术中进行了修复。56例CT检查结果为阴性的患者均无心脏损伤的进一步临床证据。在这种情况下，CT诊断心包积血的敏感性、特异性和准确性分别为100%（95%CI 18-100%）、96.6%（95%CI 88-100%）和96.7%（95%CI 89-100%）。
胸部CT可能是诊断穿透性胸部损伤时心包积血的一项有用检查。需要注意的是，患者必须脱离密切监测的环境，作者建议在无法进行超声心动图检查时，对稳定型穿透性胸部创伤患者使用CT检查。
