Barton E D, Jacoby A
Department of Emergency Medicine, University of California, San Diego Medical Center, USA.
J Emerg Med. 1996 Nov-Dec;14(6):743-5. doi: 10.1016/s0736-4679(96)00188-6.
A 21-year-old male presented to the trauma unit after he was stabbed once with a knife in the left anterior chest. The patient was awake and combative, very intoxicated, with a systolic blood pressure of 90 mmHg by palpation and a heart rate of 110 beats per min. Physical examination revealed distended neck veins, a single 1.5 cm stab wound to the left parasternal area at the third ICS (noted by clip on x-ray, Fig. 1), poorly auscultated heart sounds, and palpable femoral pulses that went away with inspiration. Chest radiograph (Fig. 1) showed a "pear-shaped" cardiac silhouette, though not markedly enlarged, and a significant left hemothorax. A diagnosis of acute pericardial tamponade was made, and the patient was taken immediately to the operating room for thoracotomy and successful repair of a stab wound of the right ventricle. Figure 2 (courtesy of Richard Wolfe, MD, Massachusetts General Hospital, Boston, MA) presents an example of an echocardiogram depicting a pericardial effusion. Pericardial fluid is imaged as a black (hypoechoic) crescent area separating the apex of the heart from the pericardium, seen as a white ring (arrow) at the inferior aspect of the scan. Tamponade is defined sonographically as the presence of both pericardial effusion (PE) and diastolic collapse of the right ventricle. Figure 3 (courtesy of Michael H. Picard, MD, of Harvard Medical School, Boston, MA) demonstrates the collapse of the right ventricular outflow track (RVOT) and its position relative to the left ventricle (LV), the left atrium (LA), and the aortic valve (AV).
一名21岁男性在左前胸被刀刺伤一次后被送至创伤科。患者清醒且好斗，处于醉酒状态，触诊收缩压为90 mmHg，心率为110次/分钟。体格检查发现颈静脉怒张，左胸骨旁第三肋间有一处1.5 cm的刺伤（X线片上可见夹子标记，图1），心音听诊不清，股动脉搏动可触及，但吸气时消失。胸部X线片（图1）显示心脏轮廓呈“梨形”，虽未明显增大，但有大量左侧血胸。诊断为急性心包填塞，患者立即被送往手术室进行开胸手术，成功修复右心室刺伤。图2（由马萨诸塞州波士顿市麻省总医院的医学博士理查德·沃尔夫提供）展示了一幅描绘心包积液的超声心动图示例。心包液在图像上表现为一个黑色（低回声）新月形区域，将心脏心尖与心包分隔开，心包在扫描下方可见为一个白色环（箭头）。超声心动图上，心包填塞定义为同时存在心包积液（PE）和右心室舒张期塌陷。图3（由马萨诸塞州波士顿市哈佛医学院的医学博士迈克尔·H·皮卡德提供）展示了右心室流出道（RVOT）的塌陷及其相对于左心室（LV）、左心房（LA）和主动脉瓣（AV）的位置。
