PDF(Pubmed)
Abstract：
BACKGROUND: Pericardial rupture caused by blunt chest trauma is rare in clinical practice. Because of its atypical clinical symptoms, and because surgeons are often unfamiliar with the clinical and radiological manifestations of the injury, preoperative diagnosis is difficult; it is easily misdiagnosed and causes serious consequences.
METHODS: A 60-year-old man, previously healthy, was transported to the emergency room after falling from a great height. Upon arrival, his vital signs were stable. Electrocardiography and echocardiography were performed, and there was no sign of cardiac injury or ischemia. Chest and abdomen computerized tomography revealed pneumopericardium, hemopneumothorax, lung contusion, multiple rib fractures on the right side (Figure 1), and right scapula and clavicle fractures. He was admitted to the inpatient department for further observation after tube thoracostomy. The next day, the patient suddenly experienced rapid arrhythmia (the ventricular rate reached 150-180 beats/min) when turning onto his right side, accompanied by a blood pressure drop to 70/45 mm Hg and a chief complaint of palpitation. Thoracoscopy was performed urgently, and a large vertical tear (8 cm × 6 cm) was found in the pericardium. The defect was successfully repaired using a heart Dacron patch. His postoperative condition was uneventful without any fluctuations in vital signs, and he was transferred to the orthopedics department for further surgery on postoperative day 8.
CONCLUSIONS: Although the possibility of pericardial rupture combined with cardiac hernia is extremely low, it is one of the causes of cardiogenic shock following blunt trauma. Therefore, clinicians need to be more familiar with its characteristic manifestations and maintain a high degree of vigilance against such injuries to avoid disastrous consequences.
METHODS: A 60-year-old man, previously healthy, was transported to the emergency room after falling from a great height. Upon arrival, his vital signs were stable. Electrocardiography and echocardiography were performed, and there was no sign of cardiac injury or ischemia. Chest and abdomen computerized tomography revealed pneumopericardium, hemopneumothorax, lung contusion, multiple rib fractures on the right side (Figure 1), and right scapula and clavicle fractures. He was admitted to the inpatient department for further observation after tube thoracostomy. The next day, the patient suddenly experienced rapid arrhythmia (the ventricular rate reached 150-180 beats/min) when turning onto his right side, accompanied by a blood pressure drop to 70/45 mm Hg and a chief complaint of palpitation. Thoracoscopy was performed urgently, and a large vertical tear (8 cm × 6 cm) was found in the pericardium. The defect was successfully repaired using a heart Dacron patch. His postoperative condition was uneventful without any fluctuations in vital signs, and he was transferred to the orthopedics department for further surgery on postoperative day 8.
CONCLUSIONS: Although the possibility of pericardial rupture combined with cardiac hernia is extremely low, it is one of the causes of cardiogenic shock following blunt trauma. Therefore, clinicians need to be more familiar with its characteristic manifestations and maintain a high degree of vigilance against such injuries to avoid disastrous consequences.
摘要：
背景：闭合性胸部创伤引起的心包破裂在临床上很少见。由于其临床症状不典型,而且由于外科医生通常不熟悉损伤的临床和放射学表现，术前诊断困难,易误诊,造成严重后果。
方法：一位60岁的老人，以前很健康,从高处坠落后被送往急诊室。抵达后,他的生命体征稳定。进行了心电图和超声心动图检查，没有心脏损伤或缺血的迹象.胸部和腹部计算机断层扫描显示心包积气，血气胸,肺挫伤,右侧多处肋骨骨折（图1），右肩胛骨和锁骨骨折.他被送进住院部接受导管胸廓造口术后进一步观察。第二天,患者转向右侧时突然出现快速心律失常（心室率达到150-180次/分钟），伴有血压降至70/45mmHg和主要的心悸。紧急进行胸腔镜检查，在心包中发现了较大的垂直撕裂（8cm×6cm）。使用心脏涤纶补片成功修复了缺陷。他的术后情况平稳，生命体征没有任何波动，术后第8天，他被转移到骨科接受进一步手术。
结论：尽管心包破裂合并心脏疝的可能性极低，它是钝性创伤后心源性休克的原因之一。因此,临床医生需要更加熟悉其特征性表现，并对此类损伤保持高度警惕，以避免灾难性后果。
方法：一位60岁的老人，以前很健康,从高处坠落后被送往急诊室。抵达后,他的生命体征稳定。进行了心电图和超声心动图检查，没有心脏损伤或缺血的迹象.胸部和腹部计算机断层扫描显示心包积气，血气胸,肺挫伤,右侧多处肋骨骨折（图1），右肩胛骨和锁骨骨折.他被送进住院部接受导管胸廓造口术后进一步观察。第二天,患者转向右侧时突然出现快速心律失常（心室率达到150-180次/分钟），伴有血压降至70/45mmHg和主要的心悸。紧急进行胸腔镜检查，在心包中发现了较大的垂直撕裂（8cm×6cm）。使用心脏涤纶补片成功修复了缺陷。他的术后情况平稳，生命体征没有任何波动，术后第8天，他被转移到骨科接受进一步手术。
结论：尽管心包破裂合并心脏疝的可能性极低，它是钝性创伤后心源性休克的原因之一。因此,临床医生需要更加熟悉其特征性表现，并对此类损伤保持高度警惕，以避免灾难性后果。
