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Tinzin L, Gao X, Li H, Zhao S. Sudden death associated with delayed cardiac rupture: case report and literature review. Front Cardiovasc Med 2024; 11:1355818. [PMID: 38682101 PMCID: PMC11045948 DOI: 10.3389/fcvm.2024.1355818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/03/2024] [Indexed: 05/01/2024] Open
Abstract
Cardiac injury plays a critical role in the process of thoracic trauma-related fatal outcomes. Historically, most patients who suffer a cardiac rupture typically die at the scene of occurrence or in the hospital, despite prompt medical intervention. Delayed cardiac rupture, although rare, may occur days after the initial injury and cause sudden unexpected death. Herein, we present the clinical details of a young man who suffered a chest stab injury and recovered well initially, but died days later due to delayed cardiac rupture. The forensic autopsy confirmed delayed cardiac rupture as the cause of death. We also reviewed previous similar reports to provide suggestions in such rare cases in clinical and forensic practice.
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Affiliation(s)
- Lopsong Tinzin
- Sichuan Ding Cheng Judical Expertise Center, Chengdu, China
| | - Xuefei Gao
- Department of Pediatric Surgery and Urology-Andrology, First Moscow State Medical University named after Sechenov, Moscow, Russia
| | - Hui Li
- Sichuan Ding Cheng Judical Expertise Center, Chengdu, China
| | - Shuquan Zhao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
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Emigh B, Grigorian A, Dilday J, Condon F, Nahmias J, Schellenberg M, Martin M, Matsushima K, Inaba K. Risk factors and outcomes in pediatric blunt cardiac injuries. Pediatr Surg Int 2023; 39:195. [PMID: 37160488 DOI: 10.1007/s00383-023-05478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Unlike adults, less is known of the etiology and risk factors for blunt cardiac injury (BCI) in children. Identifying risk factors for BCI in pediatric patients will allow for more specific screening practices following blunt trauma. METHODS A retrospective review was performed using the Trauma Quality Improvement Program (TQIP) database from 2017 to 2019. All patients ≤ 16 years injured following blunt trauma were included. Demographics, mechanism, associated injuries, injury severity, and outcomes were collected. Univariate and multivariate regression was used to determine specific risk factors for BCI. RESULTS Of 266,045 pediatric patients included in the analysis, the incidence of BCI was less than 0.2%. The all-cause mortality seen in patients with BCI was 26%. Motor-vehicle collisions (MVCs) were the most common mechanism, although no association with seatbelt use was seen in adolescents (p = 0.158). The strongest independent risk factors for BCI were pulmonary contusions (OR 15.4, p < 0.001) and hemothorax (OR 8.9, p < 0.001). CONCLUSIONS Following trauma, the presence of pulmonary contusions or hemothorax should trigger additional screening investigations specific for BCI in pediatric patients.
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Affiliation(s)
- Brent Emigh
- Division of Trauma and Critical Care, Department of Surgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 454, Providence, RI, 02903, USA.
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Joshua Dilday
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Freeman Condon
- Division of General Surgery, Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Matthew Martin
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC, University of Southern California, Los Angeles, CA, USA
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Sessa F, Cocimano G, Esposito M, Zuccarello P, Scoto E, Mazzeo P, Salerno M. Systematic Review of Penetrating Cardiac Injury by a Firearm: Forensic Implications. Healthcare (Basel) 2023; 11:265. [PMID: 36673633 PMCID: PMC9859264 DOI: 10.3390/healthcare11020265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Penetrating injuries of the heart, named penetrating cardiac injury (PCI), may cause hemorrhagic shock as well as cardiac tamponade, leading to death if not treated immediately. This systematic review aims to highlight the main aspects of penetrating cardiac injuries after firearm wounds. The cases of 39 subjects (age 37.05 + 15.4) were selected (6 fatal cases). Specifically, 4/39 cases involved subjects under 18 y.o.; analyzing the entrance wound, in 30/39 cases it was located in the anterior chest, 4/39 in the posterior chest, 3/39 in the shoulder/axilla area, 1/39 in the neck, and 1/39 in the pelvis (gluteus). The exit wound was found in only 3/39 cases. Several factors may influence the prognosis: firstly, prompt intervention represents a crucial point, then considering the complications related to PCI, the most important are myocardial infarction, and projectile migration with embolization. The mortality rate is related to: (1) area and severity of the heart injury; (2) duration of transport and intervention; (3) contemporary lesion to other organ/s; (4) the quantity of blood lost; (5) and presence/absence of cardiac tamponade. Based on these findings, a correct approach in the management of PCI may be considered important from a forensic point of view, both as regards to medical liability and from the trial perspective.
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Affiliation(s)
- Francesco Sessa
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Giuseppe Cocimano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Vanvitelli”, 80121 Napoli, Italy
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Pietro Zuccarello
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Edmondo Scoto
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Pietro Mazzeo
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
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Gentile G, Tambuzzi S, Giovanetti G, Zoja R. Sudden death due to cardiac contusion: Forensic implications in a rare pediatric case. J Forensic Sci 2021; 66:1996-2001. [PMID: 33960426 PMCID: PMC8453835 DOI: 10.1111/1556-4029.14741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 10/28/2022]
Abstract
Blunt chest trauma (BCT) often results in blunt cardiac injuries of little clinical concern, but cases of severe heart damage with high mortality rates have also been described. In particular, BCT should never be underestimated, especially when it is located in the anterior thoracic region. Among traffic accidents, motorcyclists are the most vulnerable and at the greatest risk. We report the case of a 14-year-old boy who experienced BCT following a motorcycle accident. He was evaluated at the hospital and was found to be in good medical condition, without bruises or rib fractures. Electrocardiography revealed a left bundle branch block. The patient was kept overnight for observation and was discharged the following morning in a good health condition. However, five days later, the patient suddenly died. Autopsy revealed a cardiac contusion associated with a full-thickness myocardial rupture and massive hemopericardium. Histologically, hemorrhagic infiltration foci, fibrin deposits, neutrophilic granulocytes, and well-defined areas of necrosis were detected in the context of recent fibrosis. Coronary thrombosis was not observed. The cause of death was identified as cardiac contusion that caused myocardial necrosis and, ultimately, cardiac rupture. Because the boy suffered a recent BCT and was assessed at the hospital, issues of medical malpractice were raised. This case demonstrates the potential lethality of blunt chest trauma in pediatric patients and demonstrates the importance of not underestimating such events, even in the absence of clinically identified chest injuries.
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Affiliation(s)
- Guendalina Gentile
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Milano, Italy
| | - Stefano Tambuzzi
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Milano, Italy
| | - Giulio Giovanetti
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Milano, Italy
| | - Riccardo Zoja
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Milano, Italy
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Moga HK, Parmar AP, Gohil ND. An autopsy case of death due to AC compressor blast - A rare case illustrating primary, secondary, tertiary & quaternary blast injuries. J Forensic Leg Med 2021; 80:102173. [PMID: 33895542 DOI: 10.1016/j.jflm.2021.102173] [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: 12/25/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022]
Abstract
Blast injuries seen in various accidents involving pressurized containers like gas cylinders, tires, et cetera, and acts of terrorism. The associated factors can vary from poor handling of equipment to inadequate safety precautions. These injuries include a variety of injuries, such as, injuries due to shock wave, burns, fractures, et cetera, involving multi-organ systems, especially lungs and hollow organs, due to the high-pressurized shock wave. The presented case is of the death of a 24-years-old male as a result of a blast of the compressor present in the AC outdoor unit during the filling of the gas. Here, the body showed injuries due to shock wave, secondary impact, tertiary impact because of fall on the ground, and quaternary injuries due to burns. The cause of death was Blast lung associated with Subarachnoid hemorrhage.
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Affiliation(s)
- Hemal K Moga
- Government Medical College & Sir Takhtasinhji General Hospital, Department of Forensic Medicine & Toxicology, Near State Transport Bus Station, Bhavnagar, Gujarat, 364002, India.
| | - Amit P Parmar
- Government Medical College & Sir Takhtasinhji General Hospital, Department of Forensic Medicine & Toxicology, Near State Transport Bus Station, Bhavnagar, Gujarat, 364002, India.
| | - Neha D Gohil
- Sir Takhtasinhji General Hospital, Near District Jail, Bhavnagar, Gujarat, 364002, India.
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Pines G, Gotler Y, Lazar LO, Lin G. Clinical significance of rib fractures' anatomical patterns. Injury 2020; 51:1812-1816. [PMID: 32482430 DOI: 10.1016/j.injury.2020.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Rib fractures are common and carry significant morbidity. Chest CT provides an accurate mapping of the fractures. The aim of this study is to propose an anatomical classification of rib fractures, and assess their relation to complication development. METHOD The records of all blunt trauma patients between January 1st 2014 and December 31st 2017 at a university hospital were retrospectively reviewed. Wounded who were hospitalized with rib fractures (two and more) as the primary injury were included in the study. Based on the chest CT scans, the cohort was divided into five groups: upper ribs (1-4) fractures, anterior, lateral and posterior middle ribs (4-7) fractures, and lower ribs (9-12) fractures. Data regarding demographics, complications (pneumothorax, hemothorax, chest drains, pulmonary contusion atelectasis, pneumonia, respiratory failure and death), intensive care admission and hospital stay were collected. RESULTS A total of 102 wounded were included in the study, with a mean age of 46.3 years. The mean number of fractured ribs per person was 3.82±1.68, and 46 wounded had displaced fractures. Rib fracture distribution was: upper ribs - 13.7%, anterior middle ribs - 28.5%, lateral middle ribs fractures - 27.5%, posterior middle ribs - 14.7%, lower ribs fractures - 15.7%. Wounded sustaining lateral middle ribs fractures had the highest complications rates in relation to any other fracture location group, with 25% respiratory failure rate. CONCLUSIONS Lateral middle ribs fractures are associated with a higher complication rate and may require closer oabservation.
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Affiliation(s)
- Guy Pines
- Department of Thoracic Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel; Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel.
| | - Yakov Gotler
- Department of Radiology, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel
| | - Li Or Lazar
- Department of Thoracic Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel; Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel
| | - Guy Lin
- Department of Surgery, Kaplan Medical Center, Rehovot and The Hebrew University Medical School, Jerusalem, Israel.
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