A Case Report of Occult Liver Laceration, Ribs Fracture and Hemothorax Presented with Bradycardia and Hypotension

A 76 year-old male with prior medical history of hypertension, minor stroke, and mild dementia was admitted to our hospital because of bradycardia and hypotension requiring dopamine and norepinephrine for hemodynamic support. Chest X-ray showed borderline cardiomegaly and bilateral pleural effusion. Abdominal ultra-sonography showed a hepatic lesion over S6, which was suspected to be a hematoma or space occupying lesion. Computed tomography revealed liver laceration (7 cm in depth) in S6 with hemoperitoneum, and fractures of the right 7th-10th ribs with hemothorax. After our aggressive treatment including chest tube drainage and transarterial embolization to his laceration, patient's general condition improved gradually. He was discharged after 25 days of hospitalization. Patient's dementia and bilateral pleural effusion might be the possible causes to the delay diagnosis of the liver laceration and rib fractures. We hereby report our experience in managing this case.

關鍵字

computed tomographic scan ； hemothorax ； rib fracture ； transarterial embolization

並列摘要

一位76歲男性，有高血壓、輕度中風、輕度失智病史，最初因為心跳過慢和低血壓入院。我們給予Dopamine and levophed（norepinephrine）靜脈注射來控制低血壓。病患胸部X光顯示心臟擴大和雙側肋膜積液。腹部超音波顯示有肝臟S6區之病變，初步認為是血腫或其他病灶。電腦斷層掃描顯示S6肝臟裂傷（7cm深）合併腹腔積血，右側第7－10肋骨骨折合併血胸。經過胸管引流、經動脈栓塞肝裂傷等積極治療，患者情況逐漸好轉。住院25天後出院。患者的失智和雙側胸腔積液可能是延遲診斷肝裂傷和肋骨骨折的可能原因。本文將我們處理此病患的經驗加以報告。

並列關鍵字

電腦斷層掃描；血胸；肋骨骨折；經動脈栓塞

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