心包破裂的间接诊断鉴定

Indirect Diagnosis of Pericardial Rupture

法医临床鉴定过程中发现有心包积液时,需要对是否存在心包破裂及心脏损伤进行鉴别,从而正确地评定人体损伤程度。本文通过对一例胸部刀刺伤致心包中等量积液但未开胸手术治疗痊愈伤者的临床资料进行分析,将CT平扫和增强图像中观察到的心包积液与胸腔积液及心血的密度进行比较,判断心包积液的性质和心脏及心包内大血管有无破裂;根据心电图和心肌酶谱检查判断心肌有无损伤,并由上述判断认定伤者是因被刀刺伤胸部导致胸壁及纵隔内组织损伤和心包破裂,血液经心包破裂口进入心包腔形成心包积血,而无心脏及心包内大血管损伤。证明通过临床资料对外伤性心包积液的性质和来源作出判断,依据影像学检查对心包破裂进行间接诊断是可行的。

In order to accurately assess the degree of body injury when pericardial effusion was found in forensic clinical identification, whether there is a pericardial rupture or heart injury is required. A case, where the involved person had a moderate pericardial effusion caused by a stabbed wound in the chest after cured without surgery, is introduced here. By comparison of the observed density of the pericardial effusion with that of both the pleutal effusion and the heart blood from CT plain scanning and enhanced images, the nature of pericardial effusion was determined along with or without cardiac or intra-pericardial rupture of large blood vessels. Whether there is a heart injury was judged by ECG and myocardial enzyme spectrum test. Based on the above observation, the hematopericardium was confirmed to result from the chest injury and the pericardial rupture caused by the stabbed wound instead of cardiac and intrapericardial rupture of large blood vessels. As such, a conclusion can be drawn that it is feasible to either judge the nature and cause of traumatic pericardial effusion based on the clinical data or conduct the indirect diagnosis of pericardial rupture through the medical imaging examination.