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Traumatic cardiac dislocation-A case report and review of the literature including a new classification system. J Trauma Acute Care Surg 2020; 87:944-953. [PMID: 31453985 DOI: 10.1097/ta.0000000000002445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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2
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Luxatio cordis—surgical treatment followed by venovenous extracorporal membrane oxygenation. Am J Emerg Med 2015; 33:1109.e1-2. [DOI: 10.1016/j.ajem.2015.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/10/2015] [Indexed: 11/23/2022] Open
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3
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Co SJ, Yong-Hing CJ, Galea-Soler S, Ruzsics B, Schoepf UJ, Ajlan A, Aljan A, Farand P, Nicolaou S. Role of imaging in penetrating and blunt traumatic injury to the heart. Radiographics 2012; 31:E101-15. [PMID: 21768229 DOI: 10.1148/rg.314095177] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac injury due to blunt or penetrating chest trauma is common and is associated with significant morbidity and mortality. Understanding the mechanisms, types, and complications of cardiac injuries and the roles of various imaging modalities in characterizing them is important for appropriate diagnosis and treatment. These injuries have not been well documented at imaging, but there are now fast and accurate methods for evaluating the heart and associated mediastinal structures. The authors review the broad spectrum of injuries that can result from blunt or penetrating trauma to the chest, as well as the imaging modalities commonly used in the acute trauma setting for evaluation of the heart and mediastinal structures. A pictorial review of both common and, to date, rarely documented cardiac injuries imaged with a variety of modalities is also presented. While many imaging modalities are available, the authors demonstrate the value of multidetector computed tomography (CT) for the initial evaluation of patients with blunt or penetrating chest trauma. With the advent of multidetector CT, imaging of cardiac injury has increased and accurate identification of these rare but potentially lethal injuries has become paramount for improving survival. Selection of the most appropriate modality for evaluation and recognition of the imaging findings in cardiac injuries in the acute trauma setting is important to expedite treatment and improve survival.
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Affiliation(s)
- Steven J Co
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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4
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Avaro JP, Bonnet PM. Prise en charge des traumatismes fermés du thorax. Rev Mal Respir 2011; 28:152-63. [DOI: 10.1016/j.rmr.2010.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 09/26/2010] [Indexed: 11/30/2022]
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Rippey JCR, Rao S, Fatovich D. Blunt traumatic rupture of the pericardium with cardiac herniation. CAN J EMERG MED 2010; 6:126-9. [PMID: 17433163 DOI: 10.1017/s1481803500009106] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Traumatic rupture of the pericardium with cardiac herniation is rare. Clinicians are often unfamiliar with the clinical and radiological manifestations of the injury, and the diagnosis is frequently missed preoperatively. This case report describes a patient with multiple trauma following a fall from a height, who developed this injury. The diagnosis was not made preoperatively despite suggestive clinical, electrocardiographic and radiological findings. Clinicians need to be aware of the presentation of this potentially fatal injury so that the diagnosis can be made and treatment instituted at an earlier stage. Pericardial rupture with cardiac herniation presents as cardiogenic shock, mimicking cardiac tamponade.
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Sherren PB, Galloway R, Healy M. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports. Scand J Trauma Resusc Emerg Med 2009; 17:64. [PMID: 20003497 PMCID: PMC2804570 DOI: 10.1186/1757-7241-17-64] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 12/15/2009] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Blunt Traumatic Pericardial Rupture (BTPR) with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%. METHODS We present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injury CONCLUSION BTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with:Cardiovascular instability with no obvious cause. Prominent or displaced cardiac silhouette and asymmetrical large volume pneumopericardium. Potentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest.
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Affiliation(s)
- Peter B Sherren
- Department of Anaesthesia and Intensive care, The Royal London Hospital, Whitechapel, E1 1BB, UK.
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Posttraumatic and Postoperative Cardiac Luxation: Computed Tomography Findings in Nine Patients. ACTA ACUST UNITED AC 2008; 64:721-6. [DOI: 10.1097/ta.0b013e3180341fa9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Khraim FM. The Wider Scope of Video-Assisted Thoracoscopic Surgery. AORN J 2007; 85:1199-1208; quiz 1209-12. [PMID: 17560858 DOI: 10.1016/j.aorn.2007.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Indexed: 11/15/2022]
Abstract
In the past, rudimentary devices were used to look closely into the chest; currently, advanced video technology, computers, and high-tech electronics are being used to perform many surgical procedures that formerly required a large, open incision. The goal of video-assisted thoracoscopic surgery (VATS) is the same as for comparable open procedures, but it is accomplished with less pain, less patient morbidity, and a shorter hospital stay. In addition to evaluating and treating thoracic injuries, VATS has demonstrated effectiveness in detecting and managing many other conditions, such as pleural disease, interstitial lung disease, and thoracic malignancies.
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Affiliation(s)
- Fadi M Khraim
- University of New York at Buffalo, School of Nursing, USA
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Pichakron KO, Perlstein J. Blunt traumatic pericardial rupture presenting with cardiac herniation. ACTA ACUST UNITED AC 2006; 63:275-80. [PMID: 16843780 DOI: 10.1016/j.cursur.2006.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Poletti PA, Platon A, Shanmuganathan K, Didier D, Kalangos A, Terrier F. Asymptomatic traumatic pericardial rupture with partial right atrial herniation: case report. ACTA ACUST UNITED AC 2005; 58:1068-72. [PMID: 15920427 DOI: 10.1097/01.ta.0000171990.63817.5a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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Sohn JH, Song JW, Seo JB, Do KH, Lee JS, Kim DK, Song KS, Lim TH. Case report: pericardial rupture and cardiac herniation after blunt trauma: a case diagnosed using cardiac MRI. Br J Radiol 2005; 78:447-9. [PMID: 15845942 DOI: 10.1259/bjr/31146905] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pericardial rupture following blunt chest trauma is rare, and is not usually diagnosed pre-operatively. If pericardial rupture is not recognized and treated promptly, it may be fatal owing to cardiac herniation. We report a case of traumatic herniation of the heart for which a CT scan and MRI made a major contribution to the diagnosis.
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Affiliation(s)
- J H Sohn
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
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12
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Affiliation(s)
- Riyad Karmy-Jones
- Harborview Medical Center, University of Washington, Seattle, Washington, USA
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Lang-Lazdunski L, Chapuis O, Pons F, Jancovici R. [Videothoracospy in thoracic trauma and penetrating injuries]. ANNALES DE CHIRURGIE 2003; 128:75-80. [PMID: 12657542 DOI: 10.1016/s0003-3944(02)00039-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Videothoracoscopy represents a valid and useful approach in some patients with blunt chest trauma or penetrating thoracic injury. This technique has been validated for the treatment of clotted hemothorax or posttraumatic empyema, traumatic chylothorax, traumatic pneumothorax, in patients with hemodynamic stability. Moreover, it is probably the most reliable technique for the diagnosis of diaphragmatic injury. It is also useful for the extraction of intrathoracic projectiles and foreign bodies. This technique might be useful in hemodynamically stable patients with continued bleeding or for the exploration of patients with penetrating injury in the cardiac area, although straightforward data are lacking to confirm those indications. Thoracotomy or median sternotomy remain indicated in patients with hemodynamic instability or those that cannot tolerate lateral decubitus position or one-lung ventilation. Performing video-surgery in the trauma setting require expertise in both video-assisted thoracic surgery and chest trauma management. The contra-indications to videothoracoscopy and indications for converting the procedure to an open thoracotomy should be perfectly known by surgeons performing video-assisted thoracic surgery in the trauma setting. Conversion to thoracotomy or median sternotomy should be performed without delay whenever needed to avoid blood loss and achieve an adequate procedure.
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Affiliation(s)
- L Lang-Lazdunski
- Service de chirurgie thoracique et générale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140, Clamart, France
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Dato GMA, Arslanian A, Filosso PL, Aidala E, Adduci M, Bardi G, Ruffini E. Heart herniation after blunt chest trauma. J Thorac Cardiovasc Surg 2002; 123:367-8. [PMID: 11828306 DOI: 10.1067/mtc.2002.119879] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Verkroost MW, Hensens AG. Isolated pericardial rupture with left-sided haematothorax after blunt chest trauma. Eur J Cardiothorac Surg 1998; 14:517-9. [PMID: 9860210 DOI: 10.1016/s1010-7940(98)00235-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- M W Verkroost
- Department of Thoracic and Cardiovascular Surgery, Academic Hospital Nijmegen St. Radboud, The Netherlands
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Rashid MA, Ackèr A. Cardiac herniation with catheterization of the heart, inferior vena cava, and hepatic vein by a chest tube. THE JOURNAL OF TRAUMA 1998; 45:407-9. [PMID: 9715207 DOI: 10.1097/00005373-199808000-00040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M A Rashid
- Department of Surgery, Ryhov Hospital, Jönköping, Sweden
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Carrillo EH, Heniford BT, Dykes JR, McKenzie ED, Polk HC, Richardson JD. Cardiac herniation producing tamponade: the critical role of early diagnosis. THE JOURNAL OF TRAUMA 1997; 43:19-23. [PMID: 9253902 DOI: 10.1097/00005373-199707000-00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- E H Carrillo
- Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
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Badhwar V, Mulder DS. Thoracoscopy in the trauma patient: what is its role? THE JOURNAL OF TRAUMA 1996; 40:1047. [PMID: 8656464 DOI: 10.1097/00005373-199606000-00036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Hermansson U, Konstantinov I, Träff S. Lung injury with pleuropericardial rupture successfully treated by video-assisted thoracoscopy: case report. THE JOURNAL OF TRAUMA 1996; 40:1024-5. [PMID: 8656458 DOI: 10.1097/00005373-199606000-00030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- U Hermansson
- Department of Cardiothoracic Surgery, University Hospital, Linköping, Sweden
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