Retrosternal Hemomediastinum Caused by Internal Mammary Artery Injury: A Case Report and Review of the Literature

內乳動脈損傷引發的胸骨後縱隔腔血腫：一個病例報告與文獻回顧

鄭淵家(Yuan-Chia Cheng) ； 陳昭文(Chao-Wen Chen) ； 李維哲(Wei-Che Lee) ； 郭良基(Liang-Chi Kuo) ； 林杏麟(Hsing-Lin Lin)

《中華民國急救加護醫學會雜誌》 21卷2期 (2010/06) Pp. 83-87

https://doi.org/10.30018/JECCM.201006.0003

摘要

我們描述有廣泛的胸骨後縱膈血胸與高度肝臟撕裂的一名35歲的多重外傷患者。其心包膜外的填塞肇因於胸骨的骨折，我們緊接著由外科方式吸出此血腫。藉由電腦斷層血管攝影的幫助下診斷出這不常見的由鈍傷引起的內乳動脈出血。儘管在一段時間以後胸骨後的空間有儲積很多血液，手術前仍然會由於醫師的缺乏此類罕見傷害的經驗而被誤認為是心包膜出血。為了防止未注意與未處理如此嚴重的傷害，應合理考慮可能的內乳動脈傷害與及早使用電腦斷層偵測出前縱膈腔血腫與相關聯的胸骨骨折是很重要的。這也能避免誤診和保證及時的外科或動脈攝影介入。

關鍵字

鈍傷 ； 血縱膈腔 ； 內乳動脈

並列摘要

We describe a 35-year-old multi-trauma patient who had a high-grade liter laceration with extensive retrosternal hemomediastinum. Extra pericardial tamponade secondary to the fracture of the stern um was followed by the instantaneous surgical evacuation of the hematoma. Computed tomography (CT) angiography helped diagnose this uncommon entity of blunt trauma-induced internal mammary artery bleeding. Despite a large amount of blood accumulation in the retrosternal space after a period of rime, it may have been misdiagnosed as pericardiac hemorrhage before operation due to its rarity and the physician's lack of experience for this kind of problem. To prevent such disastrous injuries from being unnoticed and thus unattended, consideration should be given to possible injuries to the internal mammary artery and early detection using CT of the anterior mediastinal hematoma that is associated with a frature of the sternum is important. This can also avoid misdiagnosis and ensure prompt surgical or angiographic intervention.

並列關鍵字

blunt trauma ； hemomediastinum ； internal mammary artery