Left ventricular thrombus after seat-belt-related chest trauma

Intracardiac thrombus case caused by blunt trauma due to child abuse

Intracardiac thrombus is a rare condition in children, although there has recently been an increase in case reports in the literature. We here report an asymptomatic intracardiac thrombus caused by blunt trauma due to child abuse in a 4-year-old girl. On the echocardiogram, one can see pericardial fluid surrounding all of the heart, and a mobile mass, a thrombus of 5.8 × 9 mm in diameter, was observed in the right atrium and on the free border of the tricuspid valve. The thrombus and pericardial fluid disappeared on the follow-up echocardiogram performed after the 10-day heparin therapy.

Bilateral iliac vein thrombosis after seat belt-related trauma revealing hypoplasia of the inferior vena cava--a case report

Hypoplasia of the inferior vena cava can be revealed by a deep venous thrombosis of the lower limbs. Associated precipitating factors or clotting defects leading to thrombosis are frequently observed. A case of bilateral iliac veins thrombosis occurring after a motor vehicle accident with seat belt injury is reported, revealing hypoplasia of the inferior vena cava. This young man was totally asymptomatic up to the crash, and did not have coagulation abnormalities. The patient had a very good outcome after anticoagulant treatment with complete regression of venous thromboses. Hypoplasia of the inferior vena cava was a predisposing anatomic abnormality that led to thrombosis, but seat belt trauma was probably the precipitating factor. This observation should be kept in mind in the evaluation of a deep venous lower limb thrombosis.

Acute and long-term clinical significance of myocardial contusion following blunt thoracic trauma: results of a prospective study

BACKGROUND

The clinical significance of myocardial contusion (MC) following blunt thoracic trauma is still unknown. Accordingly, in this prospective study in a regional trauma center we investigated the acute and long-term clinical significance of MC.

METHODS

One-hundred eighteen patients with manifest or suspected blunt thoracic trauma were evaluated for cardiac injury. Initial assessment was based on results of electrocardiographic, echocardiographic, and serial enzyme measurements. A follow-up (FU) assessment conducted at 3 and 12 months, respectively, was performed using electrocardiography, echocardiography, and a bicycle ergometry exercise test.

RESULTS

Of the 118 patients in the total sample, 67 (56.8%) required admission to the surgical intensive care unit (SICU) because of the severity of their noncardiac injuries. Fourteen patients of the total sample (11.8%) were diagnosed with MC and 13 of these (92.9%) belonged to the intensive care admissions, thus representing an incidence of 19.4% in this patient group. During the hospitalization period none of the patients with MC experienced acute cardiac complications. Eighty-six patients (72.0%) were assessed at FU. No new pathologies were found except in one patient. Exercise testing revealed no ECG abnormalities and none of the patients experienced limitations on the bicycle ergometer due to a cardiac cause.

CONCLUSIONS

The incidence of 19.7% of MC in our patients with blunt chest injury requiring intensive care treatment indicates that this condition is frequent in polytraumatized patients. Outcome and prognosis in patients with MC is favorable and, thus, routine cardiac work-up is not indicated. Specific diagnostic and therapeutic measures should be limited to cases where cardiac complications develop.

Blunt thoraco-abdominal injury

Recent advances in blunt thoraco-abdominal trauma management include improvements in imaging, particularly in trauma bay ultrasound. Indications for non-operative management have expanded for solid organ and aortic injury. The physiology of abdominal compartment syndrome continues to be defined, with resulting improvements in care.