Asymptomatic traumatic pericardial rupture with partial right atrial herniation: case report

Thoracoscopic diagnosis of traumatic pericardial rupture with cardiac hernia: A case report

BACKGROUND

Pericardial rupture caused by blunt chest trauma is rare in clinical practice. Because of its atypical clinical symptoms, and because surgeons are often unfamiliar with the clinical and radiological manifestations of the injury, preoperative diagnosis is difficult; it is easily misdiagnosed and causes serious consequences.

CASE SUMMARY

A 60-year-old man, previously healthy, was transported to the emergency room after falling from a great height. Upon arrival, his vital signs were stable. Electrocardiography and echocardiography were performed, and there was no sign of cardiac injury or ischemia. Chest and abdomen computerized tomography revealed pneumopericardium, hemopneumothorax, lung contusion, multiple rib fractures on the right side (Figure 1), and right scapula and clavicle fractures. He was admitted to the inpatient department for further observation after tube thoracostomy. The next day, the patient suddenly experienced rapid arrhythmia (the ventricular rate reached 150-180 beats/min) when turning onto his right side, accompanied by a blood pressure drop to 70/45 mm Hg and a chief complaint of palpitation. Thoracoscopy was performed urgently, and a large vertical tear (8 cm × 6 cm) was found in the pericardium. The defect was successfully repaired using a heart Dacron patch. His postoperative condition was uneventful without any fluctuations in vital signs, and he was transferred to the orthopedics department for further surgery on postoperative day 8.

CONCLUSION

Although the possibility of pericardial rupture combined with cardiac hernia is extremely low, it is one of the causes of cardiogenic shock following blunt trauma. Therefore, clinicians need to be more familiar with its characteristic manifestations and maintain a high degree of vigilance against such injuries to avoid disastrous consequences.

Post traumatic left cardiac luxation: A case report

INTRODUCTION

Rupture of the pericardium complicating blunt thoracic trauma may lead to cardiac luxation if not early recognized and appropriately surgically treated. This condition is exceedingly rare and carries a high mortality rate.

CASE PRESENTATION

A 37-year-old man presented with severe multiple injuries following a road traffic crash, including blunt trauma to the thorax and abdomen. He was in a hemodynamically stable condition. The chest radiograph and CT scan revealed a leftward heart herniation through a pericardial tear, there were also non surgical hepatic and splenic lesions. The diagnosis of left cardiac luxation with no associated valvular lesions was made. Surgical exploration via a midline sternotomy revealed a protruding heart herniating into the left pleural cavity through a large tear (15 cm) of the left pericardium. Sutures with Teflon felt pledgets were performed. The postoperative chest radiograph was normal and the postoperative course was uneventful.

DISCUSSION

Post traumatic heart luxation diagnosis is clinically difficult because the scarcity of signs and lack of specificity. Chest X ray can be suggestive, and specific findings can only be detected by computed tomography, which is the most sensitive diagnostic method. Surgical management in this condition is mandatory to avoid fatal complications such as great vessels strangulation. It consists of replacing the heart in the pericardial sac and repairing the pericardial tear.

CONCLUSION

Despite its rare occurrence, trauma surgeons must be aware of cardiac luxation. Any suspicion of such a diagnosis would warrant surgical exploration to avoid fatal complications.

Imaging of cardiac herniation in traumatic pericardial rupture

Cardiac herniation as a result of traumatic pericardial rupture is a serious injury and a difficult diagnosis to make on radiographic studies. Even with the more advanced imaging modalities, this rare diagnosis remains challenging. In a high-energy traumatic setting, there are chest radiograph and multidetector computed tomography findings that are strongly suggestive of cardiac herniation. The imaging, along with greater awareness of this injury, may provide a more rapid diagnosis, thus potentially preventing the severe clinical deterioration often seen in these patients.