鈍的胸部外傷による遅発性心タンポナーデ

Delayed Cardiac Tamponade After Blunt Chest Trauma

鈍的胸部外傷において，肺損傷，肋骨損傷に加えて大血管損傷，心損傷が合併しうるが，病院搬送前の死亡率は非常に高く，迅速かつ的確に診断，対応しなければ致死的となりうる．われわれは，鈍的胸部外傷の受傷3日後に遅発性心タンポナーデをきたし，緊急手術で救命しえた症例を経験したので報告する．

Delayed cardiac tamponade following blunt chest trauma is a rare incident, and we provide a report including a literature review for further discussion. The patient is a 56-year-old male. He fell off a motorcycle and sustained contusions to the left side of his chest. He presented to our emergency department. His consciousness was clear and vital signs were normal. Computed tomography （CT） scan revealed multiple left rib fractures, left hemothorax, and left pulmonary contusion, but no pericardial effusion was detected. He returned home, and stayed at rest for a few days. He walked for 15 minutes on the third day after the injury, and he felt unwell and visited our emergency department again in a state of shock. Echocardiography and CT scan revealed significant amount of pericardial effusion, and emergency surgery was indicated. At surgery, bleeding site near the left ventricule （LV） apex was identified and hemostasis was achieved through median sternotomy. We should be careful of delayed cardiac tamponade after blunt chest trauma.