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Spannungspneumoperikard als seltene Komplikation bei schwerem Polytrauma

Tension pneumopericardium — a rare complication in multiply injured patients

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Zusammenfassung

Thoraxverletzungen sind eine häufige Folge von Verkehrsunfällen bei polytraumatisierten Patienten. Typische Verletzungsmuster sind hierbei Rippenfrakturen und schwere Lungenparenchymverletzungen, seltener in Kombination mit Zwerchfell- und Aortenrupturen. Das posttraumatische Spannungspneumoperikard nach stumpfem Thoraxtrauma ist eine äußerst seltene Komplikation, die jedoch, falls sie übersehen und nicht therapiert wird, durch Entwicklung einer Herztamponade eine schwere kardiopulmonale Beeinträchtigung nach sich ziehen kann. Das Pneumoperikard entsteht durch Aufsteigen freier Luft aus rupturierten Alveolen entlang der Gefäßstraßen bis hin zum Perikard. In Abhängigkeit von Anzahl und Lage der rupturierten Alveolen und zusätzlichen therapeutischen Faktoren wie positivem Beatmungsdruck kann es letztlich zur Herzbeuteltamponade kommen. Ziel der vorliegenden Arbeit ist es, anhand einer Fallpräsentation und kritischen Beurteilung der Literatur Diagnostik- und Therapiestrategie beim Vorliegen eines posttraumatischen Pneumoperikards aufzuzeigen.

Abstract

Thoracic injury is a relevant and common complication in multiply injured patients. Typical patterns of injury comprise rib fractures, serious lung trauma as well as diaphragmatic and aortic rupture. In contrast, posttraumatic tension pneumopericardium following blunt thoracic trauma is a very rare complication. However, if unrecognized it might provoke cardiac tamponade and death. For the development of a pneumopericardium, free air follows the vessel bundles up to the pericardium. Hence, if the number of ruptured alveoli is high, or these alveoli are placed close to the heart, and if additional risk factors, such as high inspiratory ventilation pressure, are present, a tension pneumopericardium can induce cardiac tamponade. The aim of this report is to illuminate diagnostic and therapeutic strategies for posttraumatic pneumopericardium by presentation of a case from our trauma centre and a critical discussion of the present literature.

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Ludwig-Maximilans-Universität, München

    J. Stegmaier, C. Kirchhoff, P. Biberthaler, R. Ladurner, K.-G. Kanz & W. Mutschler

  2. Institut für Klinische Radiologie, Klinikum der Universität München

    S. Buhmann & M. Körner

  3. Chirurgische Klinik und Poliklinik — Innenstadt, Ludwig-Maximilans-Universität, Nussbaumstraße 20, 80336 , München

    J. Stegmaier

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  1. J. Stegmaier
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  2. C. Kirchhoff
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  3. P. Biberthaler
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  4. S. Buhmann
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  7. K.-G. Kanz
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  8. W. Mutschler
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Stegmaier, J., Kirchhoff, C., Biberthaler, P. et al. Spannungspneumoperikard als seltene Komplikation bei schwerem Polytrauma. Unfallchirurg 109, 245–250 (2006). https://doi.org/10.1007/s00113-005-1018-9

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  • DOI: https://doi.org/10.1007/s00113-005-1018-9

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