Frontiers in medicine · 2026
Case Report: Multimodal ultrasound diagnosis of traumatic right coronary sinus rupture combined with atrial septal tears.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Wang Jinting, Yang Cui, Wu Yeshun
Аннотация
BACKGROUND: Cardiac injury in patients with severe polytrauma is often occult and carries a high mortality, making rapid and accurate diagnosis a significant clinical challenge.
CASE PRESENTATION: A 57-year-old Asian male was admitted with polytrauma and impaired consciousness for over 2 h after a fall from the 9th floor. Post-injury manifestations included confusion, restlessness, and active bleeding from multiple wounds. The initial diagnosis was polytrauma with traumatic hemorrhagic shock. Following initial resuscitation and thoracic endovascular aortic repair (TEVAR), he developed refractory hypoxemia and hemodynamic instability. Subsequent multimodal ultrasound revealed combined injuries: traumatic rupture of the right coronary sinus into the right atrium and right ventricle, multiple tears in the mid-portion of the atrial septum, and bidirectional shunt at the atrial level. The patient received comprehensive treatment, including TEVAR, mechanical ventilation, anti-infection therapy, maintenance of internal homeostasis, and nutritional support. Due to cardiopulmonary failure secondary to the cardiac injury, extracorporeal membrane oxygenation (ECMO) was initiated. Despite aggressive life-sustaining measures, the patient developed severe infection and multiple organ failure, precluding cardiac surgical intervention. He ultimately succumbed after the withdrawal of ECMO support.
CONCLUSION: In the management of polytrauma, a high index of suspicion for occult cardiac injuries is essential. Multimodal echocardiography-comprising transthoracic echocardiography, transesophageal echocardiography, and agitated saline contrast echocardiography-serves as an efficient and precise bedside diagnostic toolkit. It not only enables rapid diagnosis of complex intracardiac injuries and hemodynamic assessment but also plays a crucial role in guiding advanced life support and developing effective treatment strategies. The early and systematic application of this approach may facilitate timely intervention for critically ill patients with polytrauma.
CASE PRESENTATION: A 57-year-old Asian male was admitted with polytrauma and impaired consciousness for over 2 h after a fall from the 9th floor. Post-injury manifestations included confusion, restlessness, and active bleeding from multiple wounds. The initial diagnosis was polytrauma with traumatic hemorrhagic shock. Following initial resuscitation and thoracic endovascular aortic repair (TEVAR), he developed refractory hypoxemia and hemodynamic instability. Subsequent multimodal ultrasound revealed combined injuries: traumatic rupture of the right coronary sinus into the right atrium and right ventricle, multiple tears in the mid-portion of the atrial septum, and bidirectional shunt at the atrial level. The patient received comprehensive treatment, including TEVAR, mechanical ventilation, anti-infection therapy, maintenance of internal homeostasis, and nutritional support. Due to cardiopulmonary failure secondary to the cardiac injury, extracorporeal membrane oxygenation (ECMO) was initiated. Despite aggressive life-sustaining measures, the patient developed severe infection and multiple organ failure, precluding cardiac surgical intervention. He ultimately succumbed after the withdrawal of ECMO support.
CONCLUSION: In the management of polytrauma, a high index of suspicion for occult cardiac injuries is essential. Multimodal echocardiography-comprising transthoracic echocardiography, transesophageal echocardiography, and agitated saline contrast echocardiography-serves as an efficient and precise bedside diagnostic toolkit. It not only enables rapid diagnosis of complex intracardiac injuries and hemodynamic assessment but also plays a crucial role in guiding advanced life support and developing effective treatment strategies. The early and systematic application of this approach may facilitate timely intervention for critically ill patients with polytrauma.