心膜損傷が出血源であった鈍的外傷後心タンポナーデの1例

Cardiac Tamponade Caused by Pericardial Injury after Blunt Trauma：Report of a Case

はじめに　鈍的外傷による心膜損傷が臨床的に診断されることはまれである1，2）．少数の心膜損傷の手術例の報告では，心ヘルニアや腹部臓器が嵌入するなどの病態が問題となっていることが多い1～3）．われわれは鈍的外傷を受傷後4日目に心タンポナーデを呈し手術を施行したところ，心膜損傷が出血源であった1例を経験したので文献的考察とともに報告する．

A woman in her 50s was brought to our hospital by ambulance after being injured in a fall by six meters. She was diagnosed with multiple vertebral fractures, multiple extremity fractures, and a retroperitoneal hematoma. Pericardial effusion was not detected. On the fourth day, an echocardiogram showed pericardial effusion. Contrast-enhanced computed tomography （CT） showed circumferential pericardial effusion with a small high-density lesion near the right atrium that suggested cardiac injury. On the sixth day, surgical repair was performed by median sternotomy. When the pericardial sac was opened, bloody fluid gushed and the patient’s hemodynamic parameters dramatically improved. No injury was found on the cardiac surface；however, a small pericardial tear with a hematoma was observed near the superior vena cava, and this tear was thought to be the source of the bleeding. Fibrin glue was applied to the tear for hemostasis. The patient’s postoperative course was uneventful. Isolated pericardial injury should be considered as a bleeding origin in patients with cardiac tamponade after blunt trauma.