Zusammenfassung
Das stumpfe Thoraxtrauma ist eine häufige Verletzung bei Verkehrsunfällen. Intrathorakale Gefäßverletzungen betreffen vorwiegend die Interkostalarterien sowie die Aorta. Die Verletzung der V. azygos ist demgegenüber sehr selten. Bislang wurden 19 Fälle in der Literatur beschrieben, keiner davon im deutschen Schrifttum. Der rechtsseitige Hämatothorax mit hämorrhagischem Schock, Rippenfrakturen und/oder Frakturen des 3.–5. BWK nach stumpfem Trauma legen den Verdacht auf eine intrathorakale Gefäßverletzung nahe. Dabei ist auch an die seltene Verletzung der V. azygos zu denken. Lässt es der Zustand des Patienten zu, kann das Spiral-CT die Lokalisation der Blutungsquelle ermöglichen. Wir berichten über eine solche Verletzung im Rahmen eines Verkehrsunfalls, wobei die präoperative Diagnosestellung mit Hilfe des CT gelang. Die Angaben zu den bisher beschriebenen 19 und dem eigenen vorgestellten Fall werden ausgewertet. Es handelt sich hierbei um eine seltene Verletzung mit einer hohen Letalität, die eine rasche Diagnosestellung und Therapie erfordert.
Abstract
Blunt chest trauma is a common injury in traffic accidents. Thoracic vessel trauma frequently affects intercostal arteries, the aorta and less often the subclavian artery. Azygos vein injury is uncommon and has previously been described in only 19 cases.
The 20th case of blunt azygos vein injury due to high energy trauma as a consequence of a traffic accident is reported with a review of the literature. Preoperative diagnosis was performed by computed tomography.
Azygos vein injury is rare but potentially lethal (8/20, 40.0%). Chest radiograph with right hemothorax is reported consistently except for two cases. Fractures of ribs and/or thoracic spine (T3–5) were found in nine patients, while neither were found in 11/20 cases. Pathognomonic signs have not been described in the literature.
Early resuscitation and immediate thoracotomy with recognition and treatment of azygos vein rupture is necessary to avoid a fatal outcome.
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Herrn Prof. Dr. G. Muhr zum 60. Geburtstag gewidmet
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Walz, M., Kolbow, B., Auerbach, F. et al. Ruptur der V. azygos beim stumpfen Thoraxtrauma. Unfallchirurg 106, 764–767 (2003). https://doi.org/10.1007/s00113-003-0654-1
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DOI: https://doi.org/10.1007/s00113-003-0654-1