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Der akute Myokardinfarkt als Unfallursache

Stellenwert der Ganzkörper-CT im Schockraum, Differenzialdiagnosen und versicherungsrechtliche Aspekte

Myocardial infarction as cause of an accident

The role of multislice CT in polytrauma management, differential diagnosis and insurance aspects

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Zusammenfassung

Unser Fall zeigt erstmals die Diagnostik eines akuten Myokardinfarkts als Unfallursache in der Polytrauma-Computertomographie im Rahmen des Schockraummanagements. Dabei stellt die Kontrastmittel (KM)-CT das wichtigste Instrumentarium zur Diagnosefindung dar. Neben dem Fallbericht werden die Differenzialdiagnosen wie die Herzkontusion, die direkte Verletzung oder Dissektion der Koronararterien und der versicherungsrechtliche Aspekt der Klärung des Myokardinfarkts als Unfallursache beschrieben. In unserem Fall war die Demarkierung der Hinterwand in der KM-CT für die Diagnosefindung des Myokardinfarkts als Unfallursache wegweisend. Trotzdem ist die Abgrenzung zwischen Myokardinfarkt als Ursache oder Folge eines Unfalls schwierig. Gemeinsam mit der Lokalisation der Verletzung haben hier die Anamnese und der Unfallmechanismus Schlüsselfunktionen. Nur in der Zusammenschau kann der primäre Myokardinfarkt im Rahmen der Polytraumaversorgung frühzeitig diagnostiziert und von anderen Differenzialdiagnosen abgegrenzt werden.

Abstract

We present for the first time the use of contrast-enhanced multislice computed tomography in trauma care to detect acute myocardial infarction and verify it as the cause of a traffic accident. In addition to the case report, cardiac contusion, coronary dissection, and facets of insurance law are discussed. The determination of acute myocardial infarction, cardiac contusion, and coronary dissection can be challenging, but answers can be found in the medical history and accident details. The trauma surgeon in the emergency department must always be interested in clarifying the cause of trauma and keeping a secondary diagnosis in mind to strive for the goal of optimal and complete polytrauma care.

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Abbreviations

BE:

Basendefizit

CK:

Kreatininkinase

CK-MB:

CK-Isoenzym MB (Herzmuskeltyp)

EF:

Ejektionsfraktion

FAST:

Focused assessment with sonography for trauma

FIO2 :

Inspiratorische Sauerstoffkonzentration

Hb:

Hämoglobin

HCO3 :

Hydrogencarbonat

HF:

Herzfrequenz

Hkt:

Hämatokrit

KHK:

Koronare Herzkrankheit

LAD:

Linke vordere absteigende Koronararterie

LCX:

Linke Koronararterie

LMA:

Linker Koronararterienhauptstamm

MS-CT:

Multislice-Spiral-CT

paCO2 :

Arterieller Kohlendioxidpartialdruck

paO2 :

Arterieller Sauerstoffpartialdruck

PTCA:

Perkutane transluminale koronare Angioplastie

PTT:

Partielle Thromboplastinzeit

RCA:

Rechte Koronararterie

SpO2 :

Periphere Sauerstoffsättigung

TEE:

Transösophageale Echokardiographie

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Abt. Polytrauma, Klinik für Unfall- und Wiederherstellungschirurgie, Campus Virchow Klinikum, Charité Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    C. Kleber, B. Oswald, H.J. Bail, N.P. Haas & F. Kandziora

  2. Abteilung Orthopädie und Unfallchirurgie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland

    B. Oswald

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  1. C. Kleber
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  2. B. Oswald
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  3. H.J. Bail
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  4. N.P. Haas
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  5. F. Kandziora
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Correspondence to C. Kleber.

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Kleber, C., Oswald, B., Bail, H. et al. Der akute Myokardinfarkt als Unfallursache. Unfallchirurg 111, 1026–1032 (2008). https://doi.org/10.1007/s00113-008-1513-x

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