外傷性心破裂後の超音波検査とCT検査で心嚢液貯留の偽陰性を示した症例報告

False negative of pericardial effusion using focused assessment with sonography for trauma and enhanced CT following traumatic cardiac rupture; A case report.

• Shinichi Ijuin
• Akihiko Inoue
• Yoei Takamiyagi
• Hiroyuki Tsukayama
• Haruki Nakayama
• Shigenari Matsuyama
• Tetsunori Kawase
• Satoshi Ishihara
• Shinichi Nakayama

抄録

背景:

外傷の心嚢液貯留の同定には、外傷超音波検査（FAST）を用いた焦点型評価が有用である。しかし，心膜穿孔を伴う心破裂では，心嚢液貯留がFASTで検出されるとは限らない．我々は、FASTと強化CTでは心嚢液貯留が検出できない症例を経験した。

Background: The focused assessment with sonography for trauma (FAST) examination is helpful for the identification of pericardial effusion in trauma. However, in a cardiac rupture with a pericardial perforation, pericardial effusion is not always detected by FAST. We experienced the case that FAST and enhanced CT failed to detect pericardial effusion.

ケースプレゼンテーション:

3mの高さから落下して負傷した51歳女性が当院に運ばれてきた．外傷の超音波検査とCT検査では心嚢液貯留は認められなかったが，巨大な胸水が認められた．血行動態が不安定になっていたため，緊急に左前側胸部切開術を行った．左心膜穿孔を認めた。クラムシェル胸腔切開術で左心房付属器に直径1cmの破裂を発見した。破裂部位を縫合することで血行動態は安定した。術後経過は問題なく，入院31日後に他院に転院した．

Case presentation: A 51-year old woman injured after falling from a height of 3 m was brought to our institute. Focused assessment with sonography for trauma and enhanced computed tomography did not reveal any pericardial effusion; however, a massive hemothorax was revealed. Because the patient's hemodynamic state had become unstable, we performed an urgent left anterolateral thoracotomy. A left pericardial perforation was detected. By performing a clamshell thoracotomy, we found a rupture of 1 cm in diameter at the left atrial appendage. The hemodynamic state was stabilized by suturing the injury site. The postoperative course was uneventful, and the patient was transferred to another hospital after 31 days of admission.

結論:

左房付属器の心臓損傷は稀であり，診断や修復が困難な場合もある。大量の喀血を伴う鈍性胸部外傷の場合、外傷に対する超音波検査による集中評価では心嚢液貯留が陰性であるが、心膜穿孔を伴う心破裂を考慮すべきである。

Conclusions: Cardiac injury in the left atrial appendage is rare and sometimes difficult to diagnose and to repair. In the case of a blunt chest trauma with a massive hemothorax, although focused assessment with sonography for trauma gives negative results for pericardial effusion, a cardiac rupture with pericardial perforation should be considered.

© 2020 The Author(s).