[穿透性肺损伤并发血流动力学脑梗塞]。

Q4 Medicine Kyobu geka. The Japanese journal of thoracic surgery Pub Date : 2024-08-01
Masaya Takizawa, Tomohiko Takahashi, Kazuki Yamagishi, Hiroaki Kobayashi
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摘要

我们遇到过一例因肺部穿透性损伤并发血流动力学脑梗塞而实施急诊手术的病例。一名 45 岁的男子被一块散落的金属片击中胸部受伤,被送往附近的一家医院。他被确诊为右侧血气胸导致的失血性休克,并被插上胸管后转入本院。胸部放射线检查和计算机断层扫描(CT)显示右肺内有金属碎片,确诊为异物穿透性肺损伤。患者还伴有完全失明,病因不明。紧急手术治疗了损伤并取出了异物。从右胸腔清除了大量血液和血肿,并在右肺下叶发现了一块金属碎片。取出异物后,进行了肺缝合。第二天,头部磁共振成像显示双侧枕叶、左额叶和左小脑半球多发脑梗塞。但未发现血管闭塞或血栓,患者被诊断为失血性休克导致的血流动力学脑梗死。
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[Penetrating Lung Injury Complicated by Hemodynamic Cerebral Infarction].

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.

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