Heart herniation after blunt chest trauma

Traumatic pericardial rupture with secondary cardiac herniation in a dog

OBJECTIVE

To describe the unique finding and treatment of a dog with cardiac herniation due to traumatic pericardial rupture.

CASE SUMMARY

A 6.5-year-old entire male Yorkshire Terrier was presented for further management after being hit by a car. Despite suspected significant intrathoracic trauma at that time, the patient regained hemodynamic stability and had orthopedic surgery to correct a right iliac fracture. The patient was readmitted to the hospital 12 days following the initial visit due to considerable respiratory difficulty after accidentally being dropped several feet. Thoracic radiographs revealed an unusual severe mediastinal shift to the left with an atypical position of the cardiac silhouette against the left lateral thoracic wall. Due to the severe respiratory compromise of the patient and newly developed pneumothorax, an exploratory thoracotomy was recommended, where a complete rupture of the pericardium was identified, with secondary left-sided prolapse of the heart. Other more common intrathoracic injuries (ie, lung perforation, rib fractures) were also identified and partially repaired. The patient recovered successfully and was discharged 4 days postoperatively.

NEW OR UNIQUE INFORMATION PROVIDED

This is the first case report in the veterinary literature of traumatic pericardial rupture and cardiac herniation. According to human case descriptions, this is a rare and often fatal occurrence, which can be significantly challenging to diagnose preoperatively or antemortem. Emergency veterinary clinicians should be aware of this rare but important complication of blunt thoracic trauma. Surgical intervention may be necessary in cases with suspected or confirmed entrapment of great vessels or cardiac chambers, although these abnormalities were not present in this case.

Left ventricular aneurysm with herniation through the chest wall

Cardiac herniation is a rare event associated with a high mortality rate. It is typically seen with blunt trauma to the chest or after a pneumectomy. Signs and symptoms include arrhythmia, myocardial ischemia, and hypotension. Diagnostic modalities, such as computed tomography scan, chest roentgenogram, magnetic resonance imaging, and transthoracic and transesophageal echocardiography, are key to diagnosis. Successful management requires timely recognition along with prompt surgical intervention.

Pericardial rupture after blunt chest trauma

Traumatic pericardial rupture is a rare injury with potentially fatal consequences, usually occurring in patients who have sustained other severe injuries of the chest and abdomen. Diagnosis is difficult and is commonly made at the time of surgery. Radiographs and computed tomography of the chest may provide clues to the diagnosis. We present one case of left pleuropericardial rupture and another of traumatic diaphragmatic pericardial rupture.