Traumatic rupture of the pericardium with luxation of the heart

The Cardiac Pendulum: Blunt Rupture of the Pericardium with Strangulation of the Heart

BACKGROUND

Blunt injury of the pericardium with strangulation of the heart is a rare clinical injury.

METHODS

We conducted a review of clinical records and performed prospective collection of forensic data from a large urban medical examiner's office.

RESULTS

Ten cases of blunt injury to the pericardium were identified. All were secondary to blunt trauma. Nine of the 10 cases had associated chest wall injuries and 5 of the 10 cases had cardiac strangulation.

CONCLUSION

Pericardial lacerations are common findings at autopsy. Clinically, those that survive to the hospital have a confusing presentation. They are often diagnosed during emergent thoracotomy for hemodynamic instability. Hemodynamic deterioration associated with change in patient position may be a clue to cardiac strangulation.

Pericardial rupture and cardiac herniation after blunt chest trauma

Pericardial rupture after blunt chest trauma is rare and is associated with a high mortality rate. We describe a patient with traumatic pericardial rupture and cardiac herniation who was successfully treated surgically. Traumatic pericardial rupture is difficult to diagnose preoperatively but should be suspected whenever there is severe blunt chest trauma. If pericardial rupture is not recognized and treated promptly it could be fatal owing to cardiac herniation.

[Evaluation and treatment of cardiac injuries]

Cardiac injuries caused by a heart traumatism are not frequent but, of great importance given their high morbidity. Two different groups in terms of etiology, clinical picture, application of diagnostic techniques, treatment and prognosis can be considered. On one hand, there are cardiac injuries caused by a thoracal contusion, which provokes a contused lesion can affect the free wall, the interventricular septum, the valves, the subvalvular apparatus, the conduction system and the coronary vessels and, on the other hand, cardiac injuries caused by penetrating objects. Cardiac injury can lead to a life-threatening hemodynamic instability which mandates prompt and clear diagnostic and therapeutic approaches.

Isolated pericardial rupture with left-sided haematothorax after blunt chest trauma

Pericardial rupture after blunt chest trauma is described in the literature. The rupture is mostly caused by high velocity trauma with associated injuries. As a result the patients are often critically ill. We describe a case of a 59-year-old man who suffered from an isolated pericardial rupture with a left-sided haematothorax diagnosed 3 months after minimal blunt chest trauma. The patient was operated upon and the defect was closed without detrimental sequelae.

Cardiac herniation producing tamponade: the critical role of early diagnosis

BACKGROUND

Rupture of the pleuropericardium (PP) occurs rarely, with most patients dying of associated injuries before arriving at the hospital. Among patients who initially survive, the diagnosis is often delayed until cardiogenic shock secondary to cardiac herniation is evident.

METHODS

The records of 10 patients with PP lacerations and cardiac herniations were reviewed.

RESULTS

All but one patient had a normal chest x-ray (CXR) film on admission. After the patients became symptomatic, seven of nine had abnormal findings on CXR film demonstrating herniation of the heart into the left hemithorax. The other two patients underwent surgery without a repeat CXR film. Except for one who was taken directly to the operating room, all patients had been previously stabilized before developing cardiogenic shock, on average 9 hours after admission. Operative therapy was closure of the pericardium for five patients and completion pericardiotomy for the others. All survivors developed significant complications, and four of them died.

CONCLUSIONS

The diagnosis of PP rupture should be considered for patients with multiple trauma who develop sudden and unexpected cardiogenic shock after their initial condition has been stabilized. A repeat CXR film is diagnostic in most cases and should be used as the most efficient and expeditious route to making the diagnosis.

Cardiac trauma. Diagnosis, management, and current therapy

In cardiac trauma the two main mechanisms of injury are blunt and penetrating trauma. Common cardiac effects of trauma include myocardial rupture, contusion, laceration, pericardial insult, coronary injury, valvular damage, arrhythmias, and conduction abnormalities. Hemodynamic instability can develop rapidly and pose marked risk to patient survival. An adequate level of clinical awareness and timely use of diagnostic techniques such as echocardiography, aortography, and cardiac angiography are essential for rapid identification of cardiac trauma. Once the diagnosis is made, prompt surgical intervention is often the key to survival.

Lung injury with pleuropericardial rupture successfully treated by video-assisted thoracoscopy: case report

We present a case of lung injury with pleuropericardial rupture resulting from blunt chest trauma. A conclusive diagnosis and successful treatment was achieved by video-assisted thoracoscopy. The value of diagnostic modalities and the role of video-assisted thoracoscopy in the management of these challenging patients are discussed.

Diagnosis by video-assisted thoracoscopy of traumatic pericardial rupture with delayed luxation of the heart: case report

Isolated pericardial rupture is probably a frequently overlooked injury. We present a case of delayed heart herniation through a left pericardial tear resulting from blunt trauma. Diagnosis was achieved by video-assisted thoracoscopy, which was also helpful in the selection of the appropriate site and extent for the thoracotomy incision.

Computed tomography to diagnose pericardial rupture

Pericardial rupture from blunt thoracic trauma has a high mortality rate. We present a case of a pleuropericardial rupture with cardiac incarceration. The recent literature is reviewed and the previously unreported use of computed tomography as a diagnostic modality is discussed.

Delayed presentation of pericardial rupture with luxation of the heart following blunt trauma: a case report

OBJECTIVE

To present an unusual case of delayed presentation of pericardial rupture with luxation of the heart 6 months after the initial injury.

DESIGN

Diagnosis, outcome, associated injuries, and treatment are discussed.

METHODS

A high index of suspicion is required to make the diagnosis; no single diagnostic test can be used as a screening tool.

CONCLUSION

Once recognized, treatment of pericardial rupture is relatively simple.

Invalidity of speculated injury mechanism in autopsy reports

Postmortem and crash investigation reports were examined for 35 cases of belted automotive crash fatalities. This paper highlights those cases with speculation of the injury mechanism in the post mortem report. In two cases, the medical examiner made specific reference to a 'whiplash' mechanism of brain injury, which refers to an inertial loading of the neck without head contact. Examination of the car interior in one case indicated evidence of head contact with transfer of hair, and the other facial contact with transfer of teeth. Death was more likely due to direct head impact. In another case, the vehicle was struck laterally by another car on the far side of the driver. The medical examiner stated that the driver incurred typical 'steering wheel type' injury, while examination of the car interior indicated no consequential contact between the driver and the steering wheel. Instead, the intruding passenger door probably impacted the driver at a velocity high enough to induce fatal chest injuries. These cases demonstrate the necessity of a thorough examination of contact points in the crashed car to discern the mechanism of injury and to reconstruct the kinematics of injured occupants in a crash. They also demonstrate how 'popular' misunderstanding of mechanisms of fatal injury may be introduced and perpetuated.

[Blunt heart injuries]

Cardiac injuries were present in 16% of our patients suffering from blunt chest trauma. 25% of these cases had no concomitant rib fractures. Sonography is extremely important for evaluation. In myocardial contusion the electrocardiogram reveals mainly disturbances in repolarisation (66 out of 108 patients) and rhythm disturbances (59 patients). A ratio of CK-MB isoenzyme/total CK of over 8% is highly suggestive of myocardial injury. Continuous monitoring in ICU is mandatory. Prognosis is mainly based on additional injuries. Heart wall rupture and luxation of the heart require operative treatment. Lesions of the aortic valves are the most frequent valve injuries.

Traumatic rupture of the pericardium with dislocation of the heart

Isolated rupture of the parietal pericardium with herniation of the heart may occur following closed injury of the chest. Such a case is presented here. Clinical suspicion should be aroused by the presence of low cardiac output with localizing signs of cardiac displacement. X-ray films of the chest may reveal important clues and provide an indication for cardiac angiography, which may be diagnostic.

A case report of surgical repair of traumatic rupture of the pericardium and diaphragm

A 55 year-old male with traumatic rupture of the pericardium, diaphragm and spleen, and with crush of the pancreas was successfully operated upon. The diagnosis of rupture of the diaphragm was done on the chest X ray on admission, and the rupture of the pericardium was diagnosed at the time of laparotomy and thoracotomy. The ruptured spleen and the crushed pancreas tail were removed, and the ruptured pericardium and diaphragm were closed successively.