血行力学的脳梗塞を合併した肺穿通傷

Penetrating Lung Injury Complicated by Hemodynamic Cerebral Infarction

胸部外傷に対し手術を要する割合は高くないが，肺や心・大血管などの胸腔内臓器まで達する穿通性外傷では緊急手術が必要な場合もあり，時機を逸すれば致命的となることがある．また，出血性ショックに伴う合併症も起こりうるため，手術適応の判断は迅速かつ的確に行う必要がある．

We encountered a case in which emergency surgery was performed for a penetrating lung injury complicated by a hemodynamic cerebral infarction. A 45-year-old man sustained a chest injury due to a scattered piece of metal and was admitted to a nearby hospital. He was confirmed to have hemorrhagic shock due to a right hemopneumothorax, and a chest tube was inserted he was transferred to our hospital. Chest radiography and computed tomography （CT） revealed a metal fragment in the right lung and confirmed the diagnosis of a penetrating lung injury due to a foreign body. The patient also presented with total blindness of an unknown etiology. Emergency surgery was performed to treat the injury and remove the foreign body. A large amount of blood and hematoma were removed from the right thoracic cavity, and a metal fragment was found in the lower lobe of the right lung. After removing the foreign body, pulmonary suturing was performed. On the following day, head magnetic resonance imaging revealed multiple cerebral infarctions in the bilateral occipital lobes, left frontal lobe, and left cerebellar hemisphere. However, no vascular occlusion or thrombus was found, and the patient was diagnosed with hemodynamic cerebral infarction due to hemorrhagic shock.