先天性左侧心包缺如伴闭合性胸部外伤致三尖瓣乳头肌断裂1例

Congenital absence of left pericardium complicated with papillary muscle rupture of tricuspid valve caused by closed chest trauma:Case report

患者男,41岁,胸部闭合伤后咳嗽、呼吸困难、双侧胸部疼痛不适1天;既往无特殊病史。查体:呼吸急促,口唇、四肢末梢发绀明显,左侧胸壁淤青,三尖瓣区闻及收缩期杂音。实验室检查:动脉血气分析血氧饱和度降低(81.3%)。心电图:窦性心动过速,不完全性右束支传导阻滞。胸部CT:双侧胸腔少量积液,左侧第3~8前肋骨折。经食管超声心动图(transesophageal echocardiography,TEE):右心增大,三尖瓣前瓣脱垂伴重度反流,房间隔卵圆窝斜形分离,心房水平探及右向左分流;诊断为三尖瓣前瓣乳头肌断裂(图1A)、卵圆孔未闭。