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Naderian A, Naidoo R, Reddy T. Delayed cardiac herniation after left pneumonectomy. Radiol Case Rep 2024; 19:1436-1439. [PMID: 38292786 PMCID: PMC10827551 DOI: 10.1016/j.radcr.2023.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Cardiac herniation is a rare potentially life-threatening complication that can occur after pneumonectomy, involving displacement of the heart through a pericardial defect, which can lead to hemodynamic instability, impaired cardiac function, and in severe cases, death. We describe a case of delayed cardiac herniation 1-month post left pneumonectomy for pulmonary leiomyosarcoma.
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Affiliation(s)
- Ashkun Naderian
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Rishendran Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Taryn Reddy
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Ouachaou J, Laaribi I, Mimouni H, Mellagui Y, Bkiyar H, Housni B. Post-traumatic compressive pneumopericardium with spontaneous ventilation: Case report. Respir Med Case Rep 2021; 32:101354. [PMID: 33614406 PMCID: PMC7879037 DOI: 10.1016/j.rmcr.2021.101354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/13/2020] [Accepted: 01/27/2021] [Indexed: 11/29/2022] Open
Abstract
Pneumopericardium is a rare complication of a blunt thoracic trauma. It is defined as the presence of air in the pericardial sac. There are just a few cases described in the literature. This article brings pneumopericardium to light, reinforcing the importance of considering it within the blunt chest trauma and remarking its management with a careful monitoring for the patients whose stable or even asymptomatic with spontaneous ventilation because of the risk of tension pneumopericardium and cardiac arrest. Diagnosis is often difficult, and it can be life-threatening by the occurrence of gas tamponade. We report the case of a 48 years old patient victim of a severe traumatism with pneumothorax and pneumopericardium; he was stable with spontaneous ventilation.
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Affiliation(s)
- Jamal Ouachaou
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Ilyass Laaribi
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Hamza Mimouni
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Yassine Mellagui
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Houssam Bkiyar
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
| | - Brahim Housni
- Intensive Care Unit, Mohammed VI University Hospital Center, Faculty of Medecine and Pharmacy of Oujda, Mohammed I University, Oujda, Morocco
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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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Cook F, Mounier R, Martin M, Dhonneur G. Late diagnosis of post-traumatic ruptured pericardium with cardiac herniation. Can J Anaesth 2016; 64:94-95. [PMID: 27671800 DOI: 10.1007/s12630-016-0746-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/06/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Fabrice Cook
- Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Henri Mondor University Hospital of Paris (APHP), Créteil, France.,Paris 12 School of Medicine, Avenue du Maréchal de Lattre de Tassigny, Créteil, France
| | - Roman Mounier
- Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Henri Mondor University Hospital of Paris (APHP), Créteil, France.,Paris 12 School of Medicine, Avenue du Maréchal de Lattre de Tassigny, Créteil, France
| | - Mathieu Martin
- Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Henri Mondor University Hospital of Paris (APHP), Créteil, France. .,Paris 12 School of Medicine, Avenue du Maréchal de Lattre de Tassigny, Créteil, France.
| | - Gilles Dhonneur
- Surgical Intensive Care Unit - Trauma Center, Department of Anaesthesiology and Critical Care Medicine, Henri Mondor University Hospital of Paris (APHP), Créteil, France.,Paris 12 School of Medicine, Avenue du Maréchal de Lattre de Tassigny, Créteil, France
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Abstract
The purpose of this article is to demonstrate the commonly encountered findings in all types of thoracic trauma. It is not intended to be a systematic review of the literature, but will discuss and illustrate the differing imaging techniques which are used to diagnose common traumatic injuries in the thorax. Interventional radiology-based therapeutic interventions will be demonstrated.
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Affiliation(s)
- Benjamin Holloway
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Helen Mathias
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Peter Riley
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Tseng YH, Wu TI, Liu YC, Lin PJ, Wu MY. Venoarterial extracorporeal life support in post-traumatic shock and cardiac arrest: lessons learned. Scand J Trauma Resusc Emerg Med 2014; 22:12. [PMID: 24502644 PMCID: PMC3922023 DOI: 10.1186/1757-7241-22-12] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/05/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Venoarterial extracorporeal life support (VA-ECLS) is an effective support of acute hemodynamic collapse caused by miscellaneous diseases. However, using VA-ECLS for post-traumatic shock is controversial and may induce a disastrous hemorrhage. To investigate the feasibility of using VA-ECLS to treat post-traumatic shock or cardiac arrest (CA), a single-center experience of VA-ECLS in traumatology was reported. MATERIALS AND METHODS This retrospective study included nine patients [median age: 37 years, interquartile range (IQR): 26.5-46] with post-traumatic shock/CA who were treated with VA-ECLS in a single institution between November 2003 and October 2012. The causes of trauma were high-voltage electrocution (n = 1), penetrating chest trauma (n = 1), and blunt chest or poly-trauma (n = 7). Medians of the injury severity score and the maximal chest abbreviated injury scale were 34 (IQR: 15.5-41) and 4 (IQR: 3-4), respectively. All patients received peripheral VA-ECLS without heparin infusion for at least 24 hours. RESULTS The median time from arrival at our emergency department (ED) to VA-ECLS was 6 h (IQR: 4-47.5). The median duration of VA-ECLS was 91 h (IQR: 43-187) with a duration < 24 h in 2 patients. Among the 9 patients, 5 received VA-ECLS to treat the post-traumatic shock/CA presenting during (n = 2) or following (n = 3) damage-control surgeries for initial trauma, and another 4 patients were supported for non-surgical complications associated with initial trauma. VA-ECLS was terminated in 2 non-survivors owing to uncontrolled hemothorax or retroperitoneal hemorrhage. Three patients survived to hospital discharge. All of them received damage-control surgeries for initial trauma and experienced a complicated hospitalization after weaning off VA-ECLS. CONCLUSION Using VA-ECLS to treat post-traumatic shock/CA is challenging and requires multidisciplinary expertise.
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Affiliation(s)
| | | | | | | | - Meng-Yu Wu
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fushing Street, Kueishan Hsiang, Taoyuan, Taiwan.
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Abstract
Although echocardiography remains the standard diagnostic tool for identifying pericardial diseases, procedures with better delineation of morphology and heart function are often required. The pericardium consists of an inner visceral (epicardium) and outer parietal layer (pericardium), which constitute for the pericardial cavity. Pericardial effusion can occur as transudate, exudate, pyopneumopericardium, or hemopericardium. Potential causes are inflammatory processes, that is, pericarditis due to autoimmune or infective reasons, neoplasms, irradiation, or systemic disorders, chronic renal failure, endocrine, or metabolic diseases. Pericardial fat can mimic pericardial effusion. Using various image-acquisition sequences, MRI allows identifying and separating fluid and solid structures. Fast spin-echo T1-weighted sequences with black-blood preparation are favourably used for morphological evaluation. Fast spin-echo T2-weighted sequences, particularly with fat saturation, and short-tau inversion-recovery sequences are useful to visualize oedema and inflammation. For further tissue characterization, delayed inversion-recovery imaging is used. Therefore, image acquisition is performed at 5-20 min subsequent to contrast agent administration, the so-called technique of late gadolinium enhancement. Ventricular volumes and myocardial mass can be assessed accurately by steady-state free-precession sequences, which is required to measure cardiac function and ventricular wall stress. Constrictive pericarditis usually results from chronic inflammatory processes leading to increased stiffness, which impedes the slippage of both pericardial layers and thereby the normal cardiac filling. CT imaging can favourably assess pericardial calcification. Thus, MR and CT imaging allow a comprehensive delineation of the pericardium. Superior to echocardiography, both methods provide a larger field of view and depiction of the complete chest including abnormalities of the surrounding mediastinum and lungs. PET provides unique information on the in vivo metabolism of 18-fluorodeoxyglucose that can be superimposed on CT findings and is useful for identifying inflammatory processes or masses, for example neoplasms. These imaging techniques provide advanced information of anatomy and cardiac function to optimize the pericardial access, for example by the AttachLifter system, for diagnosis and treatment.
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Kettani A, Belkhadir Z, Tadili J, Sbihi A, Faroudy M. Pneumopéricarde compressif: une complication rare du traumatisme thoracique fermé. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0630-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mirka H, Ferda J, Baxa J. Multidetector computed tomography of chest trauma: indications, technique and interpretation. Insights Imaging 2012; 3:433-49. [PMID: 22865481 PMCID: PMC3443276 DOI: 10.1007/s13244-012-0187-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 07/10/2012] [Indexed: 12/28/2022] Open
Abstract
Background Chest traumas are a significant cause of mortality and morbidity, especially in the younger population.MethodsDiagnostic imaging plays a key role in their management. Multidetector computed tomography (MDCT) is the most important imaging method in this field. Its advantages include especially high speed and high geometric resolution in any plane.ResultsThe method allows us to view large parts of the body with minimal motion artifacts and to create accurate multiplanar and three-dimensional (3D) reformations, which make the diagnosis significantly more accurate. Because of its advantages MDCT has become the first-choice method in high-energy traumas.ConclusionThis article summarises the position of MDCT in the diagnostic algorithm of chest injuries, technical aspects of the examination and imaging findings in traumas of the individual chest compartments. Teaching Points • Diagnostic imaging plays a key role in the management of high-energy chest trauma. • MDCT is the most important imaging method in this kind of injury, as detailed information can be acquired in a short acquisition time. • Multiplanar and three-dimensional (3D) reformattings make the diagnosis significantly more accurate.
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Affiliation(s)
- Hynek Mirka
- Department of Imaging methods, Charles University and University Hospital in Pilsen, Alej Svobody 80, 304 60, Pilsen, Czech Republic,
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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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Huang YK, Lu MS, Liu KS, Liu EH, Chu JJ, Tsai FC, Lin PJ. Traumatic pericardial effusion: impact of diagnostic and surgical approaches. Resuscitation 2010; 81:1682-6. [PMID: 20692760 DOI: 10.1016/j.resuscitation.2010.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/20/2010] [Accepted: 06/27/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In trauma patients with chest injuries, traumatic pericardial effusion is an important scenario to consider because of its close linkage to cardiac injury. Even with advances in imaging, diagnosis remains a challenge and use of which surgical approach is controversial. This study reviews the treatment algorithm, surgical outcomes, and predictors of mortality for traumatic pericardial effusion. PATIENTS AND METHODS Information on demographics, mechanisms of trauma, injury scores, diagnostic tools, surgical procedures, associated injuries, and hospital events were collected retrospectively from a tertiary trauma center. RESULTS Between June 2003 and December 2009, 31 patients (23 males and 8 females) with a median age of 31 (range 16-77), who had undergone surgical drainage of pericardial effusion were enrolled in the study. Blunt trauma accounted for 27 (87.1%) insults, and penetrating injury accounted for 4 (12.9%). Patients were diagnosed by Focused Assessment with Sonography for Trauma (FAST) (8 patients), computerized tomography (7 patients), echocardiography (9 patients), and incidentally during surgery (7 patients). Notably, sixteen (51.7%) patients required surgical repair for traumatic cardiac ruptures, including 6 (19.6%) with pericardial defects who presented initially with hemothorax. The surgical approaches were subxiphoid in 8 patients (25.8%), thoracotomy in 7 (22.6%), and sternotomy in 19 (61.2%), including 3 conversions from thoracotomy. The survival to discharge rate was 77.4% (24/31). Concomitant cardiac repair, associated pericardial defects, and initial surgical approach did not affect survival, but the need for massive transfusion, cardiopulmonary cerebral resuscitation (CPCR), trauma score, and incidental discovery at surgery all had a significant impact on the outcome. CONCLUSIONS Precise diagnoses of traumatic pericardial effusions are still challenging and easily omitted even with FAST, repeat cardiac echo and CT. The number of patients with traumatic pericardial effusion requiring surgical repair is high. Standardized therapeutic protocol, different surgical approaches have not impact on survival. Correct identification, prompt drainage, and preparedness for concomitant cardiac repair seem to be the key to better outcomes.
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Affiliation(s)
- Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery and Heart Failure Center, Chang Gung Memorial Hospital, Linkou Center, Chang Gung University, College of Medicine, Taiwan, ROC.
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Gumpert R, Archan S, Matzi V, Smolle-Jüttner FM. Transdiaphragmatic repositioning of the heart in the setting of emergency laparotomy after blunt trauma. Am J Emerg Med 2009; 27:1024.e1-2. [PMID: 19857442 DOI: 10.1016/j.ajem.2008.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 12/29/2008] [Indexed: 11/25/2022] Open
Abstract
Cardiac luxation after blunt trauma is a rare condition that carries a high mortality rate. We report a case of a left pericardial rupture with partial dislocation of the heart into the left pleural cavity and cardiac strangulation in a polytraumatized patient after a severe motor vehicle accident. This case is of special interest because the patient not only had cardiovascular compromise but was also actually in cardiac arrest and being resuscitated when an emergency repositioning of the heart through the diaphragm in the setting of damage control laparotomy restored circulation. This report stresses the need for a high index of suspicion for accurate early diagnosis of pericardial rupture.
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Affiliation(s)
- Rainer Gumpert
- Department of Trauma Surgery, Medical University of Graz, 8036 Graz, Austria
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