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Offenbacher J, Kim PK, Nguyen V, Meltzer JA. Association of thoracic cage fractures and pericardial effusion in blunt trauma. Am J Emerg Med 2021; 50:729-732. [PMID: 34879494 DOI: 10.1016/j.ajem.2021.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Several case reports suggest that penetrating thoracic cage fractures are an important cause for hemopericardium and cardiac tamponade following blunt trauma. However, the prevalence of this mechanism of injury is not fully known, and considering this association may provide a better understanding of the utility of cardiac component of the FAST (Focused Assessment with Sonography for Trauma). OBJECTIVE To determine the association of thoracic cage fractures and pericardial effusion in patients with blunt trauma. METHODS We performed a retrospective, multicenter cohort study using the Trauma Quality Improvement Program (TQIP) database (2015-2017) of adults ≥18 years of age whose mechanism of injury was either a fall or motor vehicle accident. Thoracic cage fractures were defined as any rib or sternum fracture. The primary outcome was the presence of pericardial effusion. Confounding variables were accounted for using multivariable logistic regression. RESULTS We included 1,673,704 patients in the study; 226,896 (14%) patients had at least one thoracic cage fracture. A pericardial effusion was present in 4923 (0.3%) patients. When a thoracic cage fracture was present, the odds of having a pericardial effusion was significantly higher (adjusted Odds Ratio [aOR] 6.5 [95% CI: 6.1-7.0]). Patients with left and right-sided rib fractures had similar odds of a pericardial effusion (aOR 1.2 [95% CI 1.04-1.4]). Sternal fractures carried the highest odds of having a pericardial effusion (aOR 11.1 [9.9-12.3]). CONCLUSION Thoracic cage fractures secondary to blunt trauma represent a significant independent risk factor for the development of a pericardial effusion. Our findings lend support for the mechanism of bony injuries causing penetrating cardiac trauma. Given these findings, and the fact that many thoracic cage fractures are detected after the initial evaluation, we support maintaining the cardiac view in the FAST examination for all blunt trauma patients.
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Affiliation(s)
- Joseph Offenbacher
- Albert Einstein College of Medicine, Department of Emergency Medicine, Jacobi Medical Center, 1400 Pelham Pkwy S, Room 1B25, Bronx, NY 10461, USA.
| | - Peter K Kim
- Albert Einstein College of Medicine, Department of Surgery, Jacobi Medical Center, 1400 Pelham Parkway S, Rm 510, Building 1, Bronx, NY 10461, USA
| | - Vincent Nguyen
- Albert Einstein College of Medicine, Department of Emergency Medicine, Jacobi Medical Center, 1400 Pelham Pkwy S, Room 1B25, Bronx, NY 10461, USA
| | - James A Meltzer
- Albert Einstein College of Medicine, Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, 1400 Pelham Parkway S, Room 1B25, Bronx, NY 10461, USA
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2
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Hemopericardium and Cardiac Tamponade After Blunt Thoracic Trauma: A Case Series and the Essential Role of Cardiac Ultrasound. J Emerg Med 2021; 61:e40-e45. [PMID: 34215473 DOI: 10.1016/j.jemermed.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/21/2021] [Accepted: 05/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe cardiac injury caused by penetrating rib or sternal fractures after blunt chest trauma is a rare clinical entity that has been described in only a few case reports over the last half-century. As a result, questions have arisen about the utility of the cardiac component in the Focused Assessment with Sonography in Trauma (cFAST) examination in evaluating blunt trauma patients. CASE REPORT We present a series of 3 patients who sustained blunt trauma and were discovered on cFAST examination to have developed pericardial tamponade from overlying rib or sternal fractures in the emergency departments of two academic level I trauma hospitals in the United States. Why Should an Emergency Physician Be Aware of This? These cases highlight the need for emergency and trauma physicians to be aware of blunt-induced, penetrating trauma to the heart and mediastinum, and for future trauma care guidelines to consider the importance of the cFAST examination.
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Brewer JM, Tran A, Yu J, Ali MI, Poulos CM, Gates J, Underhill D, Gluck J. Application and outcomes of extracorporeal life support in emergency general surgery and trauma. Perfusion 2021; 37:575-581. [PMID: 33878977 DOI: 10.1177/02676591211009686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We analyzed the use of Extracorporeal Membranous Oxygenation (ECMO) in acute care surgery patients at our Level-1 trauma center. We hypothesized that this patient population has improved ECMO outcomes. METHODS This was a retrospective analysis of emergency general surgery and trauma patients placed on ECMO between the periods of October 2013 and February 2020. There were 10 surgical and 12 trauma patients studied, who eventually required ECMO support. ECMO support and ECMO type/modality were analyzed with injury and survival prognostic scores examined. MAIN RESULTS Overall, 16 of the 22 patients survived to hospital discharge, for a survival rate of 73%. Mean age was 34.18 years. Mean hospital length of stay was 23.4 days with mean days on ECMO equal to 7.5. The net negative fluid balance was 5.36 L. CONCLUSIONS The survival of our ECMO cohort is notably higher than previously cited studies. Our group demonstrated decreased length of time on ECMO, decreased length of stay in the hospital, and similar rates of complications compared to prior reports. ECMO is a useful modality in acute care surgical patients and should be considered in these patient populations. Our focus on net negative fluid balance for ECMO patients demonstrates improved survival. ECMO should be considered early in surgical patients and early in advanced trauma life support.
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Affiliation(s)
- Jennifer M Brewer
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - Anthony Tran
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - Jielin Yu
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - M Irfan Ali
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - C M Poulos
- Department of General Surgery, University of Connecticut, Farmington, CT, USA
| | - Jonathan Gates
- Division of Trauma and Acute Care Surgery, Hartford Healthcare, Hartford, CT, USA
| | - David Underhill
- Division of Cardiac Surgery, Hartford Healthcare, Hartford, CT, USA
| | - Jason Gluck
- Department of Cardiology and Mechanical Circulatory Support, Hartford Healthcare, Hartford, CT, USA
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Mansour J, Raptis DA, Bhalla S. Multimodality Imaging of Cardiac Trauma. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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TONG FANG, LAN FENGCHONG, CHEN JIQING, LI XIONG. EFFECT OF STEERING WHEEL HEIGHT AND INCLINATION ANGLE ON BLUNT CARDIAC INJURY DURING THE THORAX-TO-STEERING WHEEL IMPACT. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Blunt cardiac injury (BCI) in the traffic accidents usually causes serious consequences like heart failure or even death, and the impact of steering wheel to the thorax is one of the main causes of blunt heart injury. Therefore, more realistic heart models are needed to predict the biomechanical response and related injury of the heart during a thorax-to-steering wheel impact. This study developed three-dimensional finite element (FE) models of lungs, aorta and heart, and validated the models through published cadaver tests by comparing the contact force and intracardiac pressures in four heart chambers. Then, various simulations of thorax-to-steering wheel impact were carried out at different impact heights (lower, middle and higher) and different inclination angles of steering wheel (15∘, 30∘, 45∘ and 60∘) to investigate the effects of impact height and inclination angle on heart injury. The result showed that (1) the biomechanical response of the heart model was agree with the test data; (2) the contact force, myocardial stress and intracardiac pressure were decreased when the inclination angle was increased; (3) when the impact height was middle and the inclination angle of steering wheel was 15∘, the myocardial stress and intracardiac pressure were both maximum which indicated that the blunt heart injury was more likely to occur in this condition.
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Affiliation(s)
- FANG TONG
- School of Mechanical and Automotive Engineering, South China University of Technology, 510640 Guangzhou, P. R. China
- Guangdong Provincial Key Laboratory of Automotive Engineering, South China University of Technology, 510640 Guangzhou, P. R. China
| | - FENGCHONG LAN
- School of Mechanical and Automotive Engineering, South China University of Technology, 510640 Guangzhou, P. R. China
- Guangdong Provincial Key Laboratory of Automotive Engineering, South China University of Technology, 510640 Guangzhou, P. R. China
| | - JIQING CHEN
- School of Mechanical and Automotive Engineering, South China University of Technology, 510640 Guangzhou, P. R. China
- Guangdong Provincial Key Laboratory of Automotive Engineering, South China University of Technology, 510640 Guangzhou, P. R. China
| | - XIONG LI
- School of Mechanical and Automotive Engineering, South China University of Technology, 510640 Guangzhou, P. R. China
- Guangdong Provincial Key Laboratory of Automotive Engineering, South China University of Technology, 510640 Guangzhou, P. R. China
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6
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Direct cardiac rupture associated with sternal fracture following blunt trauma: A report of two case. Trauma Case Rep 2021; 32:100430. [PMID: 33665322 PMCID: PMC7905366 DOI: 10.1016/j.tcr.2021.100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/21/2022] Open
Abstract
Traumatic cardiac injury is not rare. Especially cardiac contusion with sternal fracture due to blunt trauma in common. But cardiac rupture due to direct injury from fractured sternum in very rare. There were two case of cardiac injury supposed to be due to direct injury from fractured sternum. We operated immediately, so we could save these patients. Our cases show that it's rare but blunt trauma could make sternum fracture with direct injury to right side heart.
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Singh Y, Arra A, Cawich SO, Ramlakhan S, Naraynsingh V. A case report of blunt cardiac rupture. Int J Surg Case Rep 2020; 73:244-247. [PMID: 32717678 PMCID: PMC7385032 DOI: 10.1016/j.ijscr.2020.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 01/12/2023] Open
Abstract
Cardiac rupture is a full thickness laceration of the myocardium that occurs after blunt chest trauma. They are notoriously fatal, with only a handful of patients documented to have survived this injury. In cases where there is laceration of the pericardium, cardiac injury may not be obvious on initial assessment. A high degree of suspicion along with early recognition and prompt operative intervention can reduce mortality for these disastrous injuries. Despite its rarity, a differential diagnosis of cardiac rupture should be entertained in patients with low velocity blunt chest trauma who present with haemothorax.
Introduction Cardiac rupture is a full thickness laceration of the myocardium that occurs after blunt chest trauma. They are notoriously fatal, with only a handful of patients documented to have survived. These injuries are not commonly associated with low energy chest trauma and may be overlooked as a differential in trauma cases if health care providers are not aware of their possibility. We now report the case of a patient who survived this injury. We believe this is the 16th reported survivor of blunt cardiac rupture. Presentation of case A 46-year-old construction worker was brought to the emergency department following blunt chest trauma. On arrival he was hypotensive and tachycardic. There was a transient response to intravenous fluid resuscitation. He was found to have a contusion to the left anterior chest wall and left haemothorax on imaging with normal mediastinum. Emergency left anterolateral thoracotomy revealed a pericardial and left ventricular laceration which was repaired. He was weaned off ventilatory support on day 4 post exploration and had an uneventful recovery. Discussion Survival after blunt cardiac rupture is extremely low. In the past 60 years, only 15 cases have been described where patients survived this injury. They are usually immediately fatal and are caused by high velocity injuries. Our case was interesting because, this injury was due to a low velocity injury resulting in ventricular laceration due to a displaced rib fracture. We believe this is the 16th reported survivor of blunt cardiac rupture. Conclusion It is important, therefore, for first responders to recognize that blunt cardiac rupture can also result from seemingly innocuous, low velocity injuries so that the diagnosis can at least be entertained early. Survival depends on early diagnosis and prompt thoracotomy.
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Affiliation(s)
- Yardesh Singh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Ammiel Arra
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies.
| | - Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Shammi Ramlakhan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
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Fernando RJ, Anderson BY, Augoustides JG, Zhou E, Radvansky B, Marchant BE, Morris BE, Weiss SJ, Patel PA. Traumatic Rupture of the Left Atrial Appendage: Perioperative Management and Echocardiographic Challenges. J Cardiothorac Vasc Anesth 2020; 34:1074-1081. [DOI: 10.1053/j.jvca.2019.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 12/25/2022]
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Mylonas KS, Tsilimigras DI, Texakalidis P, Hemmati P, Schizas D, Economopoulos KP. Pediatric Cardiac Trauma in the United States: A Systematic Review. World J Pediatr Congenit Heart Surg 2018; 9:214-223. [PMID: 29544413 DOI: 10.1177/2150135117747488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Literature discussing cardiac injuries in children is limited. Systematic search of PubMed identified 21 studies enrolling 1,062 pediatric patients who experienced cardiac trauma in the United States during the period 1961 to 2012. The predominant type of injury was blunt cardiac contusion affecting 59.7% (n = 634/1,062) of the study population. Motor vehicle crashes (53.5%, n = 391/731) were the leading cause of blunt cardiac trauma, while gunshot wounds (50%, n = 150/300) accounted for most penetrating injuries. Overall mortality rate was 35.2% (n = 374/1,062).
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Affiliation(s)
- Konstantinos S Mylonas
- 1 Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,2 Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Diamantis I Tsilimigras
- 2 Surgery Working Group, Society of Junior Doctors, Athens, Greece.,3 School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pavlos Texakalidis
- 2 Surgery Working Group, Society of Junior Doctors, Athens, Greece.,4 School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pouya Hemmati
- 5 Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dimitrios Schizas
- 2 Surgery Working Group, Society of Junior Doctors, Athens, Greece.,6 First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos P Economopoulos
- 2 Surgery Working Group, Society of Junior Doctors, Athens, Greece.,7 Department of Surgery, Duke University Medical Center, Durham, NC, USA
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10
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Tanizaki S, Nishida S, Maeda S, Ishida H. Non-surgical management in hemodynamically unstable blunt traumatic pericardial effusion: A feasible option for treatment. Am J Emerg Med 2018; 36:1655-1658. [PMID: 29980487 DOI: 10.1016/j.ajem.2018.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Little is known about the outcomes of deliberate non-surgical management for hemodynamically unstable patients with blunt traumatic pericardial effusion. We evaluated the efficacy of management with pericardiocentesis or subxiphoid pericardial window in hemodynamically unstable patients who reach the hospital alive with blunt traumatic pericardial effusion. METHODS We conducted a review of a consecutive series of patients with pericardial effusion following blunt trauma who arrived at Fukui Prefectural Hospital between January 1, 2009 and December 31, 2017. All patients with traumatic pericardial effusion were included, irrespective of the type of blunt trauma. RESULTS Eleven patients were identified arrived to the Emergency Department with a pericardial effusion after blunt trauma. Of the eleven patients, five patients had cardiopulmonary arrest on arrival and none survived. Of the other six patients who reached the hospital alive, five were hemodynamically unstable and clinically diagnosed with cardiac tamponade. One patient was hemodynamically stable and managed conservatively without pericardiocentesis or pericardial window. Otherwise, two patients were managed with pericardiocentesis alone. One patient was managed with pericardial window alone. One was managed with both pericardiocentesis and pericardial window. The remaining patient underwent median sternotomy because of unsuccessful pericardial drainage tube insertion. All six patients who reached the hospital alive survived. Five patients did not require surgical repair. CONCLUSION The results of the present study suggested that non-surgical management of hemodynamically unstable patients who reach hospital alive with blunt pericardial effusion may be a feasible option for treatment.
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Affiliation(s)
- Shinsuke Tanizaki
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
| | - Satoru Nishida
- Department of Cardiovascular Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Shigenobu Maeda
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiroshi Ishida
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
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11
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Layba CJ, Arango D, Griffin LW, McQuitty C, Roughneen P. Survival following blunt traumatic right ventricular free wall rupture. TRAUMA-ENGLAND 2018. [DOI: 10.1177/1460408616659683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a case of survival after ventricular wall rupture in a young man following a fall. The patient had a delayed presentation to the emergency department with normotension and a slight tachycardia. His complaints were mild dyspnea with thoracic pain. Computed tomography of his chest revealed a pericardial effusion, a right ventricular wall defect with pseudoaneurysm and active contrast extravasation. He was transferred to our tertiary care institution for emergent cardiac intervention. The patient had a unique past surgical history significant for previous median sternotomy as a child for repair of a patent foramen ovale at the age of 13 years. Upon arrival to our facility, the patient underwent surgical exploration, and a transmural defect was identified in the right ventricle. This was repaired on cardiopulmonary bypass, and the patient recovered well. Cardiac injury following blunt thoracic trauma should always be considered when a patient presents with hypotension and tachycardia. Expeditious diagnosis and intervention is required for salvage. We believe our patient’s past surgical history with previous pericardiotomy directly contributed to his survival of a typically lethal injury.
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Affiliation(s)
- Cathline J Layba
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel Arango
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Lance W Griffin
- Division of Trauma Services, University of Texas Medical Branch, Galveston, TX, USA
| | - Christopher McQuitty
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Patrick Roughneen
- Division of Cardiothoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
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12
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Yun JH, Byun JH, Kim SH, Moon SH, Park HO, Hwang SW, Kim YH. Blunt Traumatic Cardiac Rupture: Single-Institution Experiences over 14 Years. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:435-442. [PMID: 27965920 PMCID: PMC5147468 DOI: 10.5090/kjtcs.2016.49.6.435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 11/30/2022]
Abstract
Background Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results Sixteen of the 21 patients survived, and 5 (24%) died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%). The right atrium was the most common location of injury (43%). Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase–myocardial band (CK-MB) levels (p=0.042) and platelet counts (p= 0.004) between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007), worse Trauma and Injury Severity Scores (p=0.007), and higher Injury Severity Scores (p=0.004) than those who survived. Conclusion We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient’s life.
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Affiliation(s)
- Jeong Hee Yun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
| | - Sung Ho Moon
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
| | - Hyun Oh Park
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine
| | - Sang Won Hwang
- Department of Thoracic and Cardiovascular Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | - Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
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Oizumi H, Suzuki K, Hoshino H, Tatsumori T, Ichinokawa H. A case report: hemothorax caused by rupture of the left atrial appendage. Surg Case Rep 2016; 2:142. [PMID: 27889903 PMCID: PMC5124430 DOI: 10.1186/s40792-016-0270-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/23/2016] [Indexed: 11/29/2022] Open
Abstract
Cardiac rupture is defined as a full-thickness myocardial tear; this injury after blunt chest trauma is rare, and is associated with high mortality. Blunt cardiac rupture typically presents with either cardiac tamponade or massive hemothorax, and is often unrecognized in the context of blunt chest trauma. It is a little known fact that pericardial effusions can decrease due to pericardial lacerations. Hence, cardiac rupture with pericardial lacerations may be easily overlooked especially by chest surgeons. We herein report a case of hemothorax caused by rupture of the left atrial appendage. An 80-year-old male was involved in a motor vehicle crash. We made the diagnosis of hemothorax on the basis of bloody thoracic effusion and left pleural effusion on computed tomography (CT). CT also showed small pericardial effusion in amount and non-displaced rib fractures. We made a tentative diagnosis of intercostal artery injury with rib fractures, we performed left thoracotomy. However, in the operating room, we recognized that cardiac rupture led to massive hemothorax, and that hemothorax was not associated with intercostal artery injury. We repaired left atrial appendage rupture, and his postoperative course was uneventful. Cardiac rupture can present as slight pericardial effusion with hemothorax. On the basis of this case, we propose that cardiac rupture should be considered at the time of hemothorax examination with careful attention to pericardial effusions.
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Affiliation(s)
- Hiroaki Oizumi
- Department of General Thoracic Surgery, Juntendo University Shizuoka Hospital, 1129, Nagaoka, Izunokuni, Shizuoka 410-2295, Japan.
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hironobu Hoshino
- Department of General Thoracic Surgery, Juntendo University Shizuoka Hospital, 1129, Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Takahiro Tatsumori
- Department of General Thoracic Surgery, Juntendo University Shizuoka Hospital, 1129, Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
| | - Hideomi Ichinokawa
- Department of General Thoracic Surgery, Juntendo University Shizuoka Hospital, 1129, Nagaoka, Izunokuni, Shizuoka 410-2295, Japan
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Tanaka T, Sato H, Kasai K. Detection of toluene in a body buried for years with a fatal cardiac contusion. Leg Med (Tokyo) 2016; 19:67-71. [DOI: 10.1016/j.legalmed.2016.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/16/2022]
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15
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Alvarado C, Vargas F, Guzmán F, Zárate A, Correa JL, Ramírez A, Quintero DM, Ramírez EM. Trauma cardiaco cerrado. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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Shergill AK, Maraj T, Barszczyk MS, Cheung H, Singh N, Zavodni AE. Identification of Cardiac and Aortic Injuries in Trauma with Multi-detector Computed Tomography. J Clin Imaging Sci 2015; 5:48. [PMID: 26430541 PMCID: PMC4584444 DOI: 10.4103/2156-7514.163992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/02/2015] [Indexed: 11/04/2022] Open
Abstract
Blunt and penetrating cardiovascular (CV) injuries are associated with a high morbidity and mortality. Rapid detection of these injuries in trauma is critical for patient survival. The advent of multi-detector computed tomography (MDCT) has led to increased detection of CV injuries during rapid comprehensive scanning of stabilized major trauma patients. MDCT has the ability to acquire images with a higher temporal and spatial resolution, as well as the capability to create multiplanar reformats. This pictorial review illustrates several common and life-threatening traumatic CV injuries from a regional trauma center.
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Affiliation(s)
- Arvind K Shergill
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tishan Maraj
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Barszczyk
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Helen Cheung
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Navneet Singh
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Anna E Zavodni
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Byun CS, Park IH, Kim TH, Lee E, Oh JH. Cardiac Rupture of the Junction of the Right Atrium and Superior Vena Cava in Blunt Thoracic Trauma. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Prichayudh S, Kritayakirana K, Samorn P, Pak-art R, Sriussadaporn S, Sriussadaporn S, Kiatpadungkul W, Thatsakorn K, Viratanapanu I. Damage control surgery in blunt cardiac injury. ASIAN BIOMED 2014. [DOI: 10.5372/1905-7415.0801.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Blunt cardiac injury (BCI) is a rare, but life threatening injury. The treatment of BCI is surgical repair. However, in a BCI patient with hypothermia, acidosis, and coagulopathy, an attempt to control the bleeding completely by surgery alone may not be successful. Damage control principles should be used in this situation.
Objective: To study a BCI patient who underwent a successful operation using damage control principles.
Methods: We reviewed and analyzed the patient’s chart, operative notes and follow up visit records. Review of the literature regarding the issue was also conducted.
Results: We report the case of a patient with BCI who developed hypothermia and coagulopathy during surgery. Abbreviated surgical repair was performed with a right pleuropericardial window created to avoid blood accumulation in the pericardial sac. Subsequent aggressive resuscitation was performed in the intensive care unit. We accepted ongoing bleeding through the right chest tubes while correction of hypothermia and coagulopathy was undertaken. The bleeding was gradually stopped once the patient’s physiology was restored. Although the patient developed a retained right hemothorax requiring subsequent video-assisted thoracoscopic surgery on the third postoperative week, he recovered uneventfully and was discharged on postoperative day 36.
Conclusion: In patients with BCI who develop coagulopathy during surgery, terminating the operation quickly and creating a pleuropericardial window is a possible bailout solution because this can prevent postoperative cardiac tamponade without leaving the chest open. Continue bleeding from the chest tubes is acceptable provided that adequate resuscitation to correct coagulopathy is underway.
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Affiliation(s)
| | | | - Pasurachate Samorn
- Department of Surgery, Chulalongkorn University, Bangkok 10330, Thailand
| | - Rattaplee Pak-art
- Department of Surgery, Chulalongkorn University, Bangkok 10330, Thailand
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20
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Left ventricle rupture in a truck driver caused by a tire explosion. J Acute Med 2012. [DOI: 10.1016/j.jacme.2012.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Morphological evaluation of areas of damage in blunt cardiac injury and investigation of traffic accident research. Gen Thorac Cardiovasc Surg 2012; 60:31-5. [DOI: 10.1007/s11748-011-0853-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/22/2011] [Indexed: 11/25/2022]
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Abstract
Cardiac rupture is the most extreme manifestation of blunt cardiac injury. In the first half of the 20th century this lesion was uniformly fatal. Since the first successful post-traumatic cardiorrhaphy by Desforges in 1955, multiple case reports and retrospective reviews have documented successful operative repair and survival of patients with this injury. Despite these successes, blunt cardiac rupture remains associated with a high mortality rate. The rarity of this condition and the heterogeneity of the literature make determination of exact epidemiologic data difficult. The classic clinical presentation is not universal and a subset of patients may present asymptomatically. Rapid transportation to medical care, accurate timely diagnosis and emergent operative intervention are essential for successful outcome. The use of ultrasonography in the trauma bay is a key component of early identification of these injuries. Specific outcome factors associated with survival are difficult to determine and even in those who survive to medical attention mortality rates remain as high as 60—90%.
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Affiliation(s)
- Regan Berg
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Peep Talving
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kenji Inaba
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,
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23
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Nan YY, Lu MS, Liu KS, Huang YK, Tsai FC, Chu JJ, Lin PJ. Blunt traumatic cardiac rupture: therapeutic options and outcomes. Injury 2009; 40:938-45. [PMID: 19540491 DOI: 10.1016/j.injury.2009.05.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 04/20/2009] [Accepted: 05/18/2009] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cardiac rupture following blunt thoracic trauma is rarely encountered by clinicians, since it commonly causes death at the scene. With advances in traumatology, blunt cardiac rupture had been increasingly disclosed in various ways. This study reviews our experience of patients with suspected blunt traumatic cardiac rupture and proposes treatment protocols for the same. METHODS This is a 5-year retrospective study of trauma patients confirmed with blunt traumatic cardiac rupture admitted to a university-affiliated tertiary trauma referral centre. The following information was collected from the patients: age, sex, mechanism of injury, initial effective diagnostic tool used for diagnosing blunt cardiac rupture, location and size of the cardiac injury, associated injury and injury severity score (ISS), reversed trauma score (RTS), survival probability of trauma and injury severity scoring (TRISS), vital signs and biochemical lab data on arrival at the trauma centre, time elapsed from injury to diagnosis and surgery, surgical details, hospital course and final outcome. RESULTS The study comprised 8 men and 3 women with a median age of 39 years (range: 24-73 years) and the median follow-up was 5.5 months (range: 1-35 months). The ISS, RTS, and TRISS scores of the patients were 32.18+/-5.7 (range: 25-43), 6.267+/-1.684 (range: 2.628-7.841), and 72.4+/-25.6% (range: 28.6-95.5%), respectively. Cardiac injuries were first detected using focused assessment with sonography for trauma (FAST) in 4 (36.3%) patients, using transthoracic echocardiography in 3 (27.3%) patients, chest CT in 1 (9%) patient, and intra-operatively in 3 (27.3%) patients. The sites of cardiac injury comprised the superior vena cava/right atrium junction (n=4), right atrial auricle (n=1), right ventricle (n=4), left ventricular contusion (n=1), and diffuse endomyocardial dissection over the right and left ventricles (n=1). Notably, 2 had pericardial lacerations presenting as a massive haemothorax, which initially masked the cardiac rupture. The in-hospital mortality was 27.3% (3/11) with 1 intra-operative death, 1 multiple organ failure, and 1 death while waiting for cardiac transplantation. Another patient with morbid neurological defects died on the thirty-third postoperative day; the overall survival was 63.6% (7/11). Compared with the surviving patients, the fatalities had higher RTS and TRISS scores, serum creatinine levels, had received greater blood transfusions, and had a worse preoperative conscious state. CONCLUSIONS We proposed a protocol combining various diagnostic tools, including FAST, CT, transthoracic echocardiography, and TEE, to manage suspected blunt traumatic cardiac rupture. Pericardial defects can mask the cardiac lesion and complicate definite cardiac repair. Comorbid trauma, particularly neurological injury, may have an impact on the survival of such patients, despite timely repair of the cardiac lesions.
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Affiliation(s)
- Yu-Yun Nan
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Center, Chang Gung University, College of Medicine, Taiwan, ROC
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24
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Dent LL, Lee A. Survival of blunt cardiac rupture after asystolic arrest: a case report. THE JOURNAL OF TRAUMA 2009; 66:1246-1247. [PMID: 19359944 DOI: 10.1097/ta.0b013e31802e3ede] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- L Leon Dent
- Department of Surgery, Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA.
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25
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'Rib betrays heart'--a case report. Leg Med (Tokyo) 2009; 11:139-41. [PMID: 19201241 DOI: 10.1016/j.legalmed.2008.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 12/09/2008] [Accepted: 12/15/2008] [Indexed: 11/20/2022]
Abstract
Penetrating or stab injuries of the chest are not uncommon and could be accidental, suicidal or homicidal. However, the present case discusses the importance of a careful examination of an unusual presentation in a motor vehicle accident. The case presented with haemopericardium and haemothorax due to penetrating rib injury to the heart, subsequent to blunt force trauma on the posterior chest wall. This case is highlighted, so that it becomes a necessary tool for the forensic experts to have an unprejudiced approach at autopsy and come to a reasonable conclusion.
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26
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Surgical management and treatment of a traumatic right atrial rupture. Gen Thorac Cardiovasc Surg 2008; 56:551-4. [PMID: 19002755 DOI: 10.1007/s11748-008-0294-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 06/24/2008] [Indexed: 10/21/2022]
Abstract
We have treated three patients with blunt traumatic right atrial rupture, all of whom survived after an emergent cardiac repair without cardiopulmonary bypass. Cardiac tamponade was seen in two of the three cases on ultrasonographic cardiography (UCG). The site of rupture was the right atrial appendage in two cases and the superior vena cava-right atrial (SVC-RA) junction in one case. Hemostasis had been obtained at the time of pericardiotomy because of compression by hematoma. Some patients with a right atrial rupture respond to initial volume resuscitation. Suspecting some cardiac injuries in patients with traumatic pericardial effusion on UCG, a patient with a right atrial rupture can survive with a high probability, without the use of cardiopulmonary bypass.
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27
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Yoon D, Hoftman N, Ren W, Esmailian F, Schmidt P, Mahajan A. Intraoperative transesophageal echocardiography in chest trauma. THE JOURNAL OF TRAUMA 2008; 65:924-926. [PMID: 18849812 DOI: 10.1097/ta.0b013e3180f62ed2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Diana Yoon
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
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28
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Pulley SC, Nirula R. Survival of an elderly patient with blunt traumatic cardiac rupture. ACTA ACUST UNITED AC 2008; 63:E119-20. [PMID: 17554224 DOI: 10.1097/01.ta.0000246916.38229.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Steven C Pulley
- Division of Trauma and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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29
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Wang RF, Chong CF, Wang TL, Chen CC. Results of blind subxyphoid pericardiotomy (BSP) for cardiac tamponade. THE JOURNAL OF TRAUMA 2007; 62:1317; author reply 1317-8. [PMID: 17495752 DOI: 10.1097/ta.0b013e31803429b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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30
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Gavelli G, Napoli G, Bertaccini P, Battista G, Fattori R. Imaging of Thoracic Injuries. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Kaul P, Somsekhar G, Macauley G. Secondary left ventricular injury with haemopericardium caused by a rib fracture after blunt chest trauma. J Cardiothorac Surg 2006; 1:8. [PMID: 16722596 PMCID: PMC1459158 DOI: 10.1186/1749-8090-1-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 03/28/2006] [Indexed: 11/18/2022] Open
Abstract
Trauma is the third most common cause of death in the West. In the US, approximately 90,000 deaths annually are traumatic in nature and over 75% of casualties from blunt trauma are due to chest injuries. Cardiac injuries from rib fractures following blunt trauma are extremely rare. We report the unusual case of a patient who fell from a height and presented with haemopericardium and haemothorax as a result of left ventricular and lingular lacerations and was sucessfully operated upon.
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Affiliation(s)
- Pankaj Kaul
- Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, Leeds, UK
| | - Ganti Somsekhar
- Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, Leeds, UK
| | - Graeme Macauley
- Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, Leeds, UK
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Lu LH, Choi WM, Wu HR, Liu HC, Chiu WT, Tsai SH. Blunt Cardiac Rupture with Prehospital Pulseless Electrical Activity: A Rare Successful Experience. ACTA ACUST UNITED AC 2005; 59:1489-91. [PMID: 16394928 DOI: 10.1097/01.ta.0000195876.14962.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blunt cardiac rupture is highly associated with mortality. In the recent literature, the reported mortality rates of cardiac rupture ranged from 59.7% to 100%. The probability of survival for those with prehospital pulseless electrical activity was extremely low. This case report describes a rare example of survival of a female patient with life-threatening cardiac rupture and cardiac tamponade after a major car accident. The victim developed pulseless electrical activity at admission. She recovered from the accident, however, without developing any signs of neurologic deficits. This case study emphasizes the value of the primary survey of patients and prompt and accurate interventions, including focused abdominal sonography for trauma, pericardiocentesis, and an urgent thoracotomy in the operating room for primary repair of cardiac rupture without applying a cardiopulmonary bypass system. The study showed that early diagnosis and aggressive interventions are crucial factors to the successful outcome of patient's survival.
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Affiliation(s)
- Li-Hua Lu
- Department of Emergency Medicine, Mackay Memorial Hospital, Mackay Junior College of Nursing, Taipei, Taiwan, Republic of China
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33
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34
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A case of blunt injury to the superior vena cava and right atrial appendage: Mechanisms of injury and review of the literature. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.injury.2005.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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35
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Utter GH, Scherer LA, Wisner DH. Blunt Cardiac Rupture in a Patient with Prior Ventricular Septal Defect Repair: A Case Report. ACTA ACUST UNITED AC 2004; 57:635-7. [PMID: 15454815 DOI: 10.1097/01.ta.0000135351.39516.d6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Garth H Utter
- Department of Surgery, University of California, Davis, Medical Center, Sacramento, California, USA
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36
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Türk EE, Tsokos M. Blunt Cardiac Trauma Caused by Fatal Falls From Height: An Autopsy-Based Assessment of the Injury Pattern. ACTA ACUST UNITED AC 2004; 57:301-4. [PMID: 15345976 DOI: 10.1097/01.ta.0000074554.86172.0e] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Falls from height are contributing widely to population morbidity and mortality, especially in urban settings. The presence of blunt cardiac injuries can increase morbidity among these patients, leading even to death. Some clinical studies and case reports have been published on the subject, but a systematic autopsy-based approach to the subject is missing in the literature of recent decades. METHODS This study reviewed 61 cases of fatal fall from height that were subjected to a full autopsy at the Institute of Legal Medicine, Hamburg, Germany, from 1998 to 2002. The autopsy protocols and available clinical information were evaluated for assessment of the cardiac injury pattern. RESULTS Cardiac injuries were found in 33 cases (54%), all of which involved falls from heights exceeding 6 m. In 16 cases, the cardiac injuries were the cause of death or contributed to the fatal outcome. In five of these cases, the individuals possibly could have recovered from their trauma if their heart injury had been sufficiently diagnosed and adequately treated in time. The most frequent finding was pericardial tearing (45%). Tears caused by stretching of the epicardium in the area wherein the inferior vena cava leads into the right atrium and epicardial hematoma were present in 11 cases (33%). Endocardial tears of the atria were found in six cases (18%), and did not occur during falls from heights lower than 11 m. Transmural tears to the right atrium were present in 10 cases (39%), and to the left atrium in 6 cases (18%). These tears occurred with increasing frequency in relation to greater heights. When the heights were lower than 15 m, these tears were smaller than 1 cm in diameter, but when the heights exceeded 15 m, extensive irregular tears were observed. Sternal fractures were seen in 76% of all cases involving heart injuries. In 16% of these cases, the fractures were multiple. Only 18% of the cases without cardiac injuries had sternal fractures, and none of these was multiple. Thus, the presence of severe sternal fractures can be used as an indicator of possible cardiac trauma. CONCLUSIONS A thorough cardiologic diagnosis should always be performed for patients who survive a fall from height. These patients should be transported to a unit capable of performing cardiopulmonary bypass, and explorative thoracotomy should be considered.
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Affiliation(s)
- E E Türk
- Institute of Legal Medicine, University of Hamburg, Germany.
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37
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Affiliation(s)
- Riyad Karmy-Jones
- Harborview Medical Center, University of Washington, Seattle, Washington, USA
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38
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Mimasaka S, Yajima Y, Hashiyada M, Nata M, Oba M, Funayama M. A case of aortic dissection caused by blunt chest trauma. Forensic Sci Int 2003; 132:5-8. [PMID: 12689745 DOI: 10.1016/s0379-0738(02)00416-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 74-year-old woman was struck by a car travelling at about 50 km/h. On arrival at hospital, a CT scan showed dissection of the ascending and descending aorta. She collapsed and died suddenly 8h later. At autopsy, there was massive bleeding into the left pleural cavity, ruptures of the pericardium and right ventricle, and a type A thoracic aortic dissection. The cause of death was haemorrhagic shock due to rupture of the pericardium and delayed rupture of the right ventricle following trauma to the chest. The thoracic aortic dissection was not the direct cause of death although histological examination did reveal that it occurred in the accident. Traumatic aortic dissection is rare although traumatic aortic rupture is a major cause of death after blunt chest trauma. This paper discusses the mechanisms, and factors involved in aortic dissection caused by blunt trauma.
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Affiliation(s)
- Sohtaro Mimasaka
- Department of Public Health and Forensic Medicine, Tohoku University School of Medicine, Sendai 980-8575, Japan.
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39
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Martin SK, Shatney CH, Sherck JP, Ho CC, Homan SJ, Neff J, Moore EE. Blunt trauma patients with prehospital pulseless electrical activity (PEA): poor ending assured. THE JOURNAL OF TRAUMA 2002; 53:876-80; discussion 880-1. [PMID: 12435937 DOI: 10.1097/00005373-200211000-00011] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The paucity of information on the outcome of patients experiencing prehospital pulseless electrical activity (PEA) after blunt injury led to the present study. METHODS A retrospective review was performed of all blunt trauma victims with prehospital PEA from 1997 to 2001 in an urban county trauma system. RESULTS One hundred ten patients, 78 men and 32 women, met study criteria. Seventy-nine patients had PEA at the scene, and 31 experienced PEA en route to a trauma center. All patients were transported in advanced life support ambulances. Cardiopulmonary resuscitation was initiated when PEA was detected. Vital signs were regained en route or at the trauma center by 25 patients (23%). The incidence of pupillary reactivity at the scene was higher in patients who regained vital signs (48% vs. 16%). Only one patient, who has significant residual neurologic impairment, survived. The mean Injury Severity Score of this population was 45.1. CONCLUSION If these grim results are corroborated by other investigators, consideration should be given to allowing paramedics to declare blunt trauma victims with PEA dead at the scene.
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Affiliation(s)
- Sean K Martin
- Department of Surgery, Stanford University School of Medicine and Santa Clara Medical Center, San Jose, California 95128, USA
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40
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Hsieh CH, Chen RJ, Fang JF, Lin BC, Hsu YP, Kao JL, Kao YC, Yu PC, Kang SC. Surgeon-performed ultrasonography in patients with traumatic cardiac tamponade. ANZ J Surg 2002; 72:769-70. [PMID: 12534397 DOI: 10.1046/j.1445-2197.2002.02540.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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41
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Rezende Neto JB, Diniz HO, Filho CS, Abrantes WL. Blunt traumatic rupture of the heart in a child: case report and review of the literature. THE JOURNAL OF TRAUMA 2001; 50:746-9. [PMID: 11303178 DOI: 10.1097/00005373-200104000-00028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J B Rezende Neto
- Fundaçāo Hospitalar do Estado de Minas Gerais-Joāo XXII Trauma Center, Belo Horizonte, Minas Gerais, Brazil
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42
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Patetsios P, Priovolos S, Slesinger TL, Sclafani SJ, O'Neill PA. Lacerations of the left ventricle from rib fractures after blunt trauma. THE JOURNAL OF TRAUMA 2000; 49:771-3. [PMID: 11038102 DOI: 10.1097/00005373-200010000-00032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P Patetsios
- Department of Surgery, Kings County Hospital Center, Brooklyn, New York, USA
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43
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Sliker CW, Mirvis SE, Shanmuganathan K, Meyer CA. Blunt cardiac rupture: value of contrast-enhanced spiral CT. Clin Radiol 2000; 55:805-8. [PMID: 11052887 DOI: 10.1053/crad.1999.0172] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C W Sliker
- Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
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44
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45
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Fang BR, Kuo LT, Li CT, Chang JP. Isolated right atrial tear following blunt chest trauma: report of three cases. JAPANESE HEART JOURNAL 2000; 41:535-40. [PMID: 11041105 DOI: 10.1536/jhj.41.535] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Blunt chest trauma causing isolated right atrial tear and cardiac tamponade in three patients is reported. All three patients presented with hypotension, elevated central venous pressure and altered consciousness. Echocardiographic examination demonstrated pericardial effusion in all three cases. All three patients underwent operation with a median sternotomy approach without using cardiopulmonary bypass. At operation, two patients had one tear in the right atrium, the other had two tears in the right atrium. All three patients recovered uneventfully. Early use of echocardiography to detect the presence of hemopericardium and cardiac tamponade in patients with suspected atrial rupture following blunt chest trauma is advocated.
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Affiliation(s)
- B R Fang
- Division of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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46
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47
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May AK, Patterson MA, Rue LW, Schiller HJ, Rotondo MF, Schwab CW. Combined Blunt Cardiac and Pericardial Rupture: Review of the Literature and Report of a New Diagnostic Algorithm. Am Surg 1999. [DOI: 10.1177/000313489906500611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The spectrum of blunt cardiac injury varies from the asymptomatic cardiac concussion to the immediately fatal cardiac rupture. Although the majority of victims sustaining blunt cardiac rupture die before receiving medical attention, some survive to evaluation. The diagnosis of cardiac rupture, if established, typically results from the signs and symptoms of pericardial tamponade. However, some patients may have remarkably few signs and symptoms suggestive of cardiac injury and represent a significant diagnostic challenge. We provide two cases of cardiac rupture in which the diagnosis was delayed by the presence of an associated pericardial tear with decompression into the mediastinum and pleural space. In neither of the cases did existing institutional algorithms for blunt cardiac injury assist in establishing the diagnosis before the acute demise of the patient. The presence of a coexisting pericardial injury in these patients with blunt cardiac rupture obscured the diagnosis, leading to the deaths of these patients. A discussion of these two cases and review of the literature is provided with recommendations for diagnostic algorithms in patients sustaining blunt thoracic trauma with possible cardiac and pericardial injury.
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Affiliation(s)
- Addison K. May
- Department of Surgery, Section of Trauma, Burns, and Surgical Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark A. Patterson
- Department of Surgery, Section of Trauma, Burns, and Surgical Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Loring W. Rue
- Department of Surgery, Section of Trauma, Burns, and Surgical Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Henry J. Schiller
- Department of Surgery, State University of New York Health Sciences Center, Syracuse, New York
| | - Michael F. Rotondo
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - C. William Schwab
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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Abstract
Chest radiographs remain the initial imaging modality to rapidly screen patients with blunt chest trauma. Spiral CT is more sensitive and specific in diagnosing most thoracic pathology seen in blunt trauma patients. This article reviews the major clinical and radiologic findings that occur with blunt injuries to the chest, excluding mediastinal vascular injuries.
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Affiliation(s)
- K Shanmuganathan
- Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, USA
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