Hsu Y P, Chen R J, Bullard M J, Fang J F, Lin B C
Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Changgeng Yi Xue Za Zhi. 1998 Sep;21(3):343-6.
Aortic injury caused by penetration of a fractured rib is very rare. We present a patient with aortic injury demonstrated using serial imaging studies. A 66-year-old woman fell from a ladder and sustained multiple left-side rib fractures. There was a small left hemothorax and widened mediastinum on the initial chest roentgenogram in the emergency department. Chest computed tomography (CT) revealed a posterior segmental fracture of the sixth rib on the left side with a sharp edge penetrating into the posterior aspect of the thoracic aorta. It was initially missed. More than 1000 cc of fresh blood suddenly gushed out of the chest tube 7 hours after the traumatic event. After resuscitation, an aortogram was performed which showed blood extravasation from the thoracic aorta at the rib fracture site. Unfortunately, surgical intervention was delayed and she died. Early detection and early surgical intervention are necessary in patients with a widened mediastinum and positive results on imaging studies.
肋骨骨折穿透导致的主动脉损伤非常罕见。我们报告一例通过系列影像学检查证实存在主动脉损伤的患者。一名66岁女性从梯子上跌落，导致左侧多发肋骨骨折。急诊科最初的胸部X线片显示左侧少量血胸和纵隔增宽。胸部计算机断层扫描（CT）显示左侧第六肋骨后段骨折，锐利的骨折端刺入胸主动脉后方。最初该损伤被漏诊。外伤事件发生7小时后，胸腔引流管突然引出超过1000 cc的新鲜血液。复苏后进行了主动脉造影，显示肋骨骨折部位的胸主动脉有血液外渗。不幸的是，手术干预延迟，患者死亡。对于纵隔增宽且影像学检查结果呈阳性的患者，早期发现和早期手术干预是必要的。
