1
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Ricci C, Hughes J, Miles G. Endovascular Removal of Pulmonary Artery Bullet Embolus: Case Report and Literature Review. Vasc Endovascular Surg 2024:15385744241264791. [PMID: 39033397 DOI: 10.1177/15385744241264791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
The current state of the literature for a bullet embolization to the heart and/or pulmonary vasculature indicates the occurrence is rare but could increase due to the rise in civilian low-kinetic-energy firearm acquisition and use. We present the case of an older teenage male who sustained a gunshot wound to the left flank. The bullet entered the iliac vein, travelled through the heart and lodged in the pulmonary artery. Successful relocation of the bullet to the internal iliac vein was performed by the interventional radiologist. This article highlights the advancement of interventional radiology as a successful non-invasive endovascular technique for bullet embolus removal.
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Affiliation(s)
- Caesar Ricci
- Trauma Surgery, Texas Health Harris Methodist Ft. Worth Hospital, Ft. Worth, TX, USA
| | - Jonathan Hughes
- General Surgery, Texas Health Harris Methodist Ft. Worth Hospital, Ft. Worth, TX, USA
| | - Gayla Miles
- Trauma Research Texas Health Harris Methodist Ft. Worth Hospital, Ft. Worth, TX, USA
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2
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de Lange C, Rodriguez CM, Martinez-Rios C, Lam CZ. Urgent and emergent pediatric cardiovascular imaging. Pediatr Radiol 2024:10.1007/s00247-024-05980-y. [PMID: 38967787 DOI: 10.1007/s00247-024-05980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
The need for urgent or emergent cardiovascular imaging in children is rare when compared to adults. Patients may present from the neonatal period up to adolescence, and may require imaging for both traumatic and non-traumatic causes. In children, coronary pathology is rarely the cause of an emergency unlike in adults where it is the main cause. Radiology, including chest radiography and computed tomography in conjunction with echocardiography, often plays the most important role in the acute management of these patients. Magnetic resonance imaging can occasionally be useful and may be suitable in more subacute cases. Radiologists' knowledge of how to manage and interpret these acute conditions including knowing which imaging technique to use is fundamental to appropriate care. In this review, we will concentrate on the most common cardiovascular emergencies in the thoracic region, including thoracic traumatic and non-traumatic emergencies and pulmonary vascular emergencies, as well as acute clinical disorders as a consequence of primary and postoperative congenital heart disease. This review will cover situations where cardiovascular imaging may be acutely needed, and not strictly emergencies only. Imaging recommendations will be discussed according to the different clinical presentations and underlying pathology.
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Affiliation(s)
- Charlotte de Lange
- Department of Pediatric Radiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Behandlingsvägen 7, 416 50, Gothenburg, Sweden.
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | | | - Claudia Martinez-Rios
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Christopher Z Lam
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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3
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Lourenço MIC, Anson A, DeStefano IM, Logwood KS, Stockman T, Berg J. Traumatic pericardial rupture with secondary cardiac herniation in a dog. J Vet Emerg Crit Care (San Antonio) 2024; 34:399-405. [PMID: 38923376 DOI: 10.1111/vec.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/10/2022] [Accepted: 01/21/2023] [Indexed: 06/28/2024]
Abstract
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.
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Affiliation(s)
- Marisa I C Lourenço
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Agustina Anson
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Ian M DeStefano
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Katherine S Logwood
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - Tiffany Stockman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
| | - John Berg
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
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4
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Alfraidy D, Aldarsouni FG, Dagestani H, Al Ramahi GZ. An Emergency Adaptation of Anterolateral and Clamshell Thoracotomy for Blunt Traumatic Right Atrial Rupture: A Case Report. Cureus 2023; 15:e49208. [PMID: 38143623 PMCID: PMC10739582 DOI: 10.7759/cureus.49208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
The high mortality rate of blunt cardiac injuries is primarily due to the condition's severity and the challenges associated with pre-hospital survival. The absence of definitive diagnostic modalities necessitates prompt and adaptable surgical intervention. We present an 18-year-old male who sustained a right atrial blunt traumatic cardiac rupture following a motor vehicle collision. Despite initial stabilization with blood products and vasopressors and the necessitated emergent surgical exploration, the case required various surgical techniques, including anterolateral followed by an extension to a clamshell thoracotomy and laparotomy to manage the complex cardiac rupture and associated injuries. Furthermore, it underscores the critical nature of surgical incision in such patients and its impact on the overall prognosis. The successful outcome, highlighted by intraoperative decision-making and proper postoperative care, demonstrates that with timely and adaptable surgical approaches, even the most severe cases of traumatic blunt cardiac ruptures can be managed effectively.
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Affiliation(s)
- Doaa Alfraidy
- Department of Surgery, King Saud University Medical City, Riyadh, SAU
| | | | - Hatoon Dagestani
- Department of Surgery, King Saud University Medical City, Riyadh, SAU
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5
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Richardson AL, Richardson OK, Guan RL, Anderson RJ, Van Meter TL. The lifesaving effects of cardiac adhesions. Radiol Case Rep 2023; 18:2461-2464. [PMID: 37235082 PMCID: PMC10206376 DOI: 10.1016/j.radcr.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
Patients that incur myocardial disruption from penetrating cardiac injuries have an average 6%-10% expectancy rate of reaching the hospital alive. If prompt recognition on arrival is not immediate, the morbidity and mortality are significantly higher due to the secondary physiologic sequalae of either cardiogenic or hemorrhagic shock. Even after a triumphant arrival at a medical facility, out of that 6%-10%, half of those patients are not expected to survive. The unique significance of the presenting case breaks this tradition, expanding past the paradigms and issuing an exceptional understanding of the protective effects that cardiac surgery can futuristically cause through preformed adhesions. In our case, the cardiac adhesions achieved this by containing a penetrating cardiac injury that had caused complete ventricular disruption.
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Affiliation(s)
- Adam L. Richardson
- Department of Radiology, University of Louisville School of Medicine, 530 S Jackson St, Louisville, KY 40202, USA
| | - Olivia K. Richardson
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Rebecca L. Guan
- Department of Radiology, University of Louisville School of Medicine, 530 S Jackson St, Louisville, KY 40202, USA
| | - Ryan J. Anderson
- Department of Radiology, University of Louisville School of Medicine, 530 S Jackson St, Louisville, KY 40202, USA
| | - Tracy L. Van Meter
- Department of Radiology, University of Louisville School of Medicine, 530 S Jackson St, Louisville, KY 40202, USA
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6
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Okamoto S, Maeyama H. Traumatic intrapericardial diaphragmatic hernia. Acute Med Surg 2023; 10:e895. [PMID: 37814652 PMCID: PMC10560133 DOI: 10.1002/ams2.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/02/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023] Open
Abstract
Traumatic intrapericardial diaphragmatic hernias are very rare; they occur when the central tendon of the diaphragm ruptures, allowing abdominal viscera to herniate into the pericardial sac, causing life-threatening cardiac tamponade. Computed tomography imaging with multiplanar reconstruction is useful in evaluating such cases.
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Affiliation(s)
| | - Hiroki Maeyama
- Department of Emergency and Critical Care MedicineTsuyama Chuo HospitalOkayamaJapan
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7
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Bolaji T, Ekpendu AC, Giberson F. Gunshot Wound to the Chest With Retained Epicardial Bullet. Cureus 2022; 14:e29422. [PMID: 36299967 PMCID: PMC9586743 DOI: 10.7759/cureus.29422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Gunshot wounds remain the most common cause of penetrating injuries in children and adolescents and the second leading cause of death among youth in the United States. Penetrating cardiac injuries carry a significantly increased mortality rate. The extent of damage caused depends on the type of firearm, the bullet used, the velocityand the trajectory. Therefore, rapid diagnosis and treatment is of the utmost importance. We report a case of a 19-year-old boy who presented to ouremergency department (ED) after sustaining a gunshot wound (GSW) to the right chest. In the ED, the patient was stabilized and a large hematoma was evacuated during a resuscitative thoracotomy. Further thoracotomy in the operating room was done with repairs of the penetrating injuries to the heart and lungs. No bullet was identified after careful inspection of the entire chest in the operating room. However, upon further postoperative imaging, a bullet was identified on chest X-ray and CT, lodged in the anterior aspect of the subepicardial right ventricular outflow tract. After a complicated hospital course, the patient was discharged by hospital day 30 in a stable condition with outpatient follow-up. The decision to leave or retrieve a bullet should be made on a case-by-case basis depending on the clinical picture. In this case report, we have shown that leaving the bullet in place with close observation and appropriate imaging is feasible for selected patients.
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8
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Cardiac contusions in the acute care setting: Historical background, evaluation and management. Am J Emerg Med 2022; 61:152-157. [PMID: 36116330 DOI: 10.1016/j.ajem.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Albeit described since 1763, cardiac contusions is still an under-recognised clinical condition in the acute care setting. This evidence-based review aims to provide an overview of the topic by focusing on etiopathogenesis, classification and clinical presentation of patients with cardiac contusions, as well as on the diagnostic work-up and therapy options available for this subset population in the acute care setting. METHODS A targeted research strategy was performed using PubMed, MEDLINE, Embase and Cochrane Central databases up to June 2022. The literature search was conducted using the following keywords (in Title and/or Abstract): ("cardiac" OR "heart" OR "myocardial") AND ("contusion"). All available high-quality resources written in English and containing information on epidemiology, etiopathogenesis, clinical findings, diagnosis and management of cardiac contusions were included in our research. RESULTS Biochemical samples of cardiac troponins together with a 12‑lead ECG appear to be sufficient screening tools in hemodynamically stable subjects, while cardiac ultrasound provides a further diagnostic clue for patients with hemodynamic instability or those more likely to have a significant cardiac contusion. CONCLUSIONS The management of patients with suspected cardiac contusion remains a challenge in clinical practice. For this kind of patients a comprehensive diagnostic approach and a prompt emergency response are required, taking into consideration the degree of severity and clinical impairment of associated traumatic injuries.
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9
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Haenel A, Sieber LV, Barkhausen J. Eine herzzerreißende Spritztour: CT-Traumaspirale mit
außergewöhnlicher Verletzung. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1756596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A Haenel
- Klinik für Radiologie und Nuklearmedizin UKSH, Campus
Lübeck – Radiologie, Lübeck
| | - L V Sieber
- Klinik für Radiologie und Nuklearmedizin,
Universitätsklinikum Schleswig Holstein Campus Lübeck,
Lübeck
| | - J Barkhausen
- Klinik für Radiologie und Nuklearmedizin,
Universitätsklinikum Schleswig Holstein Campus Lübeck,
Lübeck
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10
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Williams BM, Mulima G, Charles A. Chest Trauma Management in Low- and Middle-Income Countries. Thorac Surg Clin 2022; 32:329-336. [PMID: 35961741 DOI: 10.1016/j.thorsurg.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Trauma is a leading cause of death and disability worldwide and disproportionately affects those in low- and middle-income countries (LMICs). Globally, two-thirds of injured patients sustain trauma to the thoracic cavity. Further research, capacity building, and increased awareness are needed to limit the high thoracic trauma-associated morbidity and mortality in LMICs.
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Affiliation(s)
| | | | - Anthony Charles
- Department of Surgery, University of North Carolina-Chapel Hill; Kamuzu Central Hospital, Lilongwe, Malawi.
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11
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Yoshihara S. Acute coronary syndrome on non-electrocardiogram-gated contrast-enhanced computed tomography. World J Radiol 2022; 14:30-46. [PMID: 35317242 PMCID: PMC8891644 DOI: 10.4329/wjr.v14.i2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/14/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
It is not rare for acute coronary syndrome (ACS) patients to present with symptoms that are atypical, rather than chest pain. It is sometimes difficult to achieve a definitive diagnosis of ACS for such patients who present with atypical symptoms, normal initial biomarkers of myocardial necrosis, and normal or nondiagnostic electrocardiograms (ECGs). Although cardiac CT allows for assessments of coronary artery stenosis as well as myocardial perfusion defect in patients with suspected ACS, it requires ECG gating and is usually performed with high-performance multislice CT for highly probable ACS patients. However, several recent reports have stated that ACS is detectable by myocardial perfusion defects even on routine non-ECG-gated contrast-enhanced CT. A growing number of contrast-enhanced CT scans are now being performed in emergency departments in search of pathologies responsible for a patient’s presenting symptoms. In order to avoid inappropriate management for this life-threatening event, clinicians should be aware that myocardial perfusion defect is more commonly detectable even on routine non-ECG-gated contrast-enhanced CT performed in search of other pathologies.
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Affiliation(s)
- Shu Yoshihara
- Department of Diagnostic Radiology, Iwata City Hospital, Iwata 438-8550, Japan
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12
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Nandkeolyar S, Bansal RC, Floridia R, Kirk S. Case Illustrations of the Utility of Echocardiography in Gunshot Wound Trauma. CASE 2022; 6:8-12. [PMID: 35243192 PMCID: PMC8883068 DOI: 10.1016/j.case.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ramesh C. Bansal
- Department of Cardiology, Loma Linda University, Loma Linda, California
- Correspondence: Ramesh C. Bansal, MD, FASE, Adult Echocardiography Laboratory, Loma Linda University School of Medicine, 11234 Anderson Street, Troesh Medical Campus, Room MC-1B-255, Loma Linda, California 92354.
| | - Rosario Floridia
- Department of Cardiothoracic Surgery, Loma Linda University, Loma Linda, California
| | - Shannon Kirk
- Department of Radiology, Loma Linda University, Loma Linda, California
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13
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The impact of intercostal nerve block on the necessity of a second chest x-ray in patients with penetrating trauma: A randomised controlled trial. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2020.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Valente T, Pignatiello M, Sica G, Bocchini G, Rea G, Cappabianca S, Scaglione M. Hemopericardium in the acute clinical setting: Are we ready for a tailored management approach on the basis of MDCT findings? LA RADIOLOGIA MEDICA 2020; 126:527-543. [PMID: 33136215 DOI: 10.1007/s11547-020-01303-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
The clinical spectrum of pericardial effusions varies from innocuous serous fluid to life-threatening hemopericardium. A misdiagnosis may be made by similar clinical presentation of acute chest pain/hypotension. Echocardiography is the first-line test for diagnosis of pericardial effusion and its etiology, but sometimes there are different drawbacks to the correct cardiovascular ultrasound diagnosis. Radiologists are reporting an increasing amount of thoracic Multidetector CT examinations at the emergency department. Multidetector CT has now become an established and complementary method for cardiac imaging, and diseases of the pericardium can now be quickly identified with increasing certainty. The aim of this review is to discuss the hemopericardium key Multidetector CT features in acute clinical setting which indicate the need to proceed with predominantly medical or surgical treatment, however, being able to identify forms of bleeding pericardial effusion for which only "a watch and wait strategy" and/or deferred treatment is indicated. In the emergency care setting, radiologists must be aware of different findings of hemopericardium in order to address a tailored and timely management approach.
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Affiliation(s)
- Tullio Valente
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy.
| | - Maria Pignatiello
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Giacomo Sica
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Giorgio Bocchini
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Gaetano Rea
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Mariano Scaglione
- Department of Diagnostic Imaging, Pineta Grande Hospital, Castelvolturno, Italy
- Department of Radiology, Tesside University, Middlesbrough, UK
- James Cook University Hospital, Middlesbrough, UK
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15
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Stojanovska J, Hurwitz Koweek LM, Chung JH, Ghoshhajra BB, Walker CM, Beache GM, Berry MF, Colletti PM, Davis AM, Hsu JY, Khosa F, Kicska GA, Kligerman SJ, Litmanovich D, Maroules CD, Meyersohn N, Syed MA, Tong BC, Villines TC, Wann S, Wolf SJ, Kanne JP, Abbara S. ACR Appropriateness Criteria® Blunt Chest Trauma-Suspected Cardiac Injury. J Am Coll Radiol 2020; 17:S380-S390. [PMID: 33153551 DOI: 10.1016/j.jacr.2020.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
Blunt cardiac injuries range from myocardial concussion (commotio cordis) leading to fatal ventricular arrhythmias to myocardial contusion, cardiac chamber rupture, septal rupture, pericardial rupture, and valvular injuries. Blunt injuries account for one-fourth of the traumatic deaths in the United States. Chest radiography, transthoracic echocardiography, CT chest with and without contrast, and CT angiography are usually appropriate as the initial examination in patients with suspected blunt cardiac injury who are both hemodynamically stable and unstable. Transesophageal echocardiography and CT heart may be appropriate as examination in patients with suspected blunt cardiac injuries. This publication of blunt chest trauma-suspected cardiac injuries summarizes the literature and makes recommendations for imaging based on the available data and expert opinion. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | | | | | | | - Garth M Beache
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | | | - Andrew M Davis
- The University of Chicago Medical Center, Chicago, Illinois; American College of Physicians
| | - Joe Y Hsu
- Kaiser Permanente, Los Angeles, California
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Mushabbar A Syed
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois; Society for Cardiovascular Magnetic Resonance
| | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Wisconsin Heart Hospital, Milwaukee, Wisconsin; Nuclear cardiology expert
| | - Stephen J Wolf
- Denver Health MC/UPI, Denver, Colorado; American College of Emergency Physicians
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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16
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Daskalaki D, Hakmi H, Stright A, Mitzman B, Mair ER, Joseph DK, Baltazar GA. Bullet embolization to the heart: A rare and confounding penetrating cardiac injury case report. Int J Surg Case Rep 2020; 73:35-38. [PMID: 32629219 PMCID: PMC7338989 DOI: 10.1016/j.ijscr.2020.06.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/21/2020] [Accepted: 06/21/2020] [Indexed: 12/02/2022] Open
Abstract
Hemodynamically stable gunshot wound patients may be managed without retrieval of the bullet. Nearly 90% of patients with cardiac bullet emboli on initial presentation are hemodynamically stable. Non-operative management of stable patients includes intensive observation and additional imaging to localize the bullet.
Gunshot wounds to the cardiac region usually result in devastating injuries. However, if bullets embolize into the myocardium without significant damage to the organ, optimal evaluation and management remains unclear. We present the case of a hemodynamically stable gunshot wound patient who presented with a bullet to the heart. Sternotomy revealed that the bullet had embolized through the superior vena cava and embedded into the apex of the right ventricle. The patient was managed without retrieval of the bullet and continues to be well despite a retained intracardiac bullet. We discuss cases of bullet embolization to the heart and the emergence of minimally-invasive approaches for management.
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Affiliation(s)
| | - Hazim Hakmi
- NYU Langone Health, Department of Surgery, United States
| | - Adam Stright
- NYU Langone Health, Department of Surgery, United States
| | - Brian Mitzman
- NYU Langone Health, Department of Cardiothoracic Surgery, United States
| | - Evan R Mair
- NYU Langone Health, Department of Radiology, United States
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17
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Fernando RJ, Anderson BY, Augoustides JG, Zhou E, Radvansky B, Marchant BE, Morris BE, Weiss SJ, Patel PA. Traumatic Rupture of the Left Atrial Appendage: Perioperative Management and Echocardiographic Challenges. J Cardiothorac Vasc Anesth 2020; 34:1074-1081. [DOI: 10.1053/j.jvca.2019.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 12/25/2022]
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18
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Qamar SR, Wu Y, Nicolaou S, Murray N. State of the Art Imaging Review of Blunt and Penetrating Cardiac Trauma. Can Assoc Radiol J 2020; 71:301-312. [PMID: 32066272 DOI: 10.1177/0846537119899200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Traumatic cardiovascular injuries are only second to the central nervous system injuries as a cause of death in young adult population. Multidetector computed tomography is the gold standard diagnostic modality in patients with blunt or penetrating chest trauma and clinical suspicion of cardiac injury. The imaging spectrum of cardiac injuries includes but not limits to pericardial rupture, myocardial contusions, valve rupture, coronary artery injuries, cardiac herniations, and cardiac tamponade. In this review article, we discuss clinical presentation, types, and mechanism of cardiac trauma with emphasis on the imaging findings and illustrations in blunt, penetrating traumatic, and iatrogenic cardiac injuries.
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Affiliation(s)
- Sadia Raheez Qamar
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuhao Wu
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Savvas Nicolaou
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Murray
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Comprehensive review of pericardial diseases using different imaging modalities. Int J Cardiovasc Imaging 2020; 36:947-969. [DOI: 10.1007/s10554-020-01784-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022]
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Van Lieshout EMM, Verhofstad MHJ, Van Silfhout DJT, Dubois EA. Diagnostic approach for myocardial contusion: a retrospective evaluation of patient data and review of the literature. Eur J Trauma Emerg Surg 2020; 47:1259-1272. [PMID: 31982920 PMCID: PMC8321993 DOI: 10.1007/s00068-020-01305-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/14/2020] [Indexed: 11/25/2022]
Abstract
Purpose Myocardial contusion can be a life-threatening condition in patients who sustained blunt thoracic trauma. The diagnostic approach remains a subject of debate. The aim of this study was to determine the sensitivity and specificity of echocardiography, electrocardiography, troponins T and I (TnT and TnI), and creatine kinase muscle/brain (CK-MB) for identifying patients with a myocardial contusion following blunt thoracic trauma. Methods Sensitivity and specificity were first determined in a 10-year retrospective cohort study and second by a systematic literature review with meta-analysis. Results Of the 117 patients in the retrospective study, 44 (38%) were considered positive for myocardial contusion. Chest X-ray, chest CT scan, electrocardiograph, and echocardiography had poor sensitivity (< 15%) but good specificity (≥ 90%). Sensitivity to cardiac biomarkers measured at presentation ranged from 59% for TnT to 77% for hs-TnT, specificity ranged from 63% for CK-MB to 100% for TnT. The systematic literature review yielded 28 studies, with 14.5% out of 7242 patients reported as positive for myocardial contusion. The pooled sensitivity of electrocardiography, troponin I, and CK-MB was between 62 and 71%, versus only 45% for echocardiography and 38% for troponin T. The pooled specificity ranged from 63% for CK-MB to 85% for troponin T and 88% for echocardiography. Conclusion The best diagnostic approach for myocardial contusion is a combination of electrocardiography and measurement of cardiac biomarkers. If abnormalities are found, telemonitoring is necessary for the early detection of life-threatening arrhythmias. Chest X-ray and CT scan may show other thoracic injuries but provide no information on myocardial contusion. Electronic supplementary material The online version of this article (10.1007/s00068-020-01305-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Dirk Jan T Van Silfhout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A Dubois
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Willett JK. Imaging in trauma in limited-resource settings: A literature review. Afr J Emerg Med 2018; 9:S21-S27. [PMID: 30976496 PMCID: PMC6440922 DOI: 10.1016/j.afjem.2018.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/16/2018] [Accepted: 07/20/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Trauma is a leading health problem and cause of death throughout both the developed and the developing world. In Africa and South Africa in particular, trauma-related injury has an increased morbidity and mortality when compared to the rest of the world, with numbers approaching a staggering two to six times the global average. Rapid diagnosis is key when it comes to identification and treatment of traumatic injuries. In locations that are limited in finances, infrastructure, and resources, a stepwise approach to imaging in trauma can lead to decreased morbidity and mortality. Tailored recommendations for imaging trauma in resource-limited settings can lead to improved diagnostics and treatment and in turn, decrease mortality. METHODS A systematic literature review was conducted, using a compilation of English-language articles found on PubMed, EMBASE, Medline, and Cochrane Library searches relevant to imaging in trauma. A total of 31 journals articles, published from 1991 to 2017 were reviewed. RESULTS From the search, 26 original articles were selected and reviewed in detail, as well as an additional five original research articles. DISCUSSION As imaging continues to evolve, its importance in the role of diagnostic algorithms in trauma settings is important. In most settings, imaging is relied upon as an adjunct to the primary survey. In most developed settings, CT scan remains the mainstay for imaging in trauma, but in limited-resource settings, other imaging studies such as LODOX, X-ray, and especially ultrasound can play a large role. As ultrasound is directly related to user operation, data are limited and variable; more research as this field evolves will be beneficial.
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Khan AM, Rafiq S, Ilyas M, Ahmad Z. Mortal Portal: Left Ventricular Free Wall Rupture. Am J Med 2018; 131:642-644. [PMID: 29391130 DOI: 10.1016/j.amjmed.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Azher Maqbool Khan
- Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Suhail Rafiq
- Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mohd Ilyas
- Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
| | - Zubair Ahmad
- Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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CT for evaluation of acute pericardial emergencies in the ED. Emerg Radiol 2018; 25:321-328. [DOI: 10.1007/s10140-018-1590-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/13/2018] [Indexed: 12/27/2022]
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Verma N, Robinson JD, Gunn ML. Pericardial rupture and cardiac herniation in blunt trauma. Radiol Case Rep 2018; 13:573-575. [PMID: 29988807 PMCID: PMC6030551 DOI: 10.1016/j.radcr.2018.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/07/2018] [Indexed: 11/29/2022] Open
Abstract
Pericardial rupture in blunt trauma is rarely seen on computed tomography (CT) imaging due to its high initial mortality. We report a case of a 53-year-old man who presented to the Emergency Department in hemodynamic shock after intentional fall from height. Chest radiograph, which was taken in the trauma bay as a part of his primary survey, showed abnormal mediastinum contour with pneumopericardium. Pericardial rupture with cardiac herniation, and tamponade secondary to pneumopericardium, was diagnosed on trauma CT scan. The patient underwent emergent surgical management with thoracotomy to reduce the herniation and repair the pericardium. Immediate suspicion for pericardial and cardiac injury on the initial chest radiograph and rapid diagnosis on CT was indispensable for this patient's favorable outcome.
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Affiliation(s)
- Nupur Verma
- University of Florida, Department of Radiology, Post Office Box 100374, Gainesville, Florida 32610-0374, USA
| | - Jeffery D Robinson
- University of Washington, Harborview Medical Center, Department of Radiology, 325 9th Ave., Seattle, WA 98104, USA
| | - Martin L Gunn
- University of Washington, Harborview Medical Center, Department of Radiology, 325 9th Ave., Seattle, WA 98104, USA
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Trauma to the heart: A review of presentation, diagnosis, and treatment. J Trauma Acute Care Surg 2017; 83:911-916. [DOI: 10.1097/ta.0000000000001667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Melo ASA, Moreira LBM, Pessoa FMC, Saint-Martin N, Ancilotti Filho R, Souza AS, Marchiori E. Tomographic aspects of penetrating thoracic trauma: injuries from firearms and other weapons. Radiol Bras 2017; 50:372-377. [PMID: 29307927 PMCID: PMC5746881 DOI: 10.1590/0100-3984.2016.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective The aim of this study was to analyze the various computed tomography findings in penetrating chest trauma, as well as to determine the frequency and extent of the lesions. Material and Methods We studied the computed tomography findings from 40 cases of penetrating thoracic trauma, of which 35 (85.8%) were gunshot wounds and 5 (14.2%) were caused by another type of weapon. Results Pulmonary lesions were found in 39 cases (97.5%), manifesting as contusions in 34 cases (85%), atelectasis in 8 (20%), lacerations in 1 (2.5%) and hematomas in 1 (2.5%). Hemothorax was seen in 31 cases (77.5%), and pneumothorax was seen in 22 cases (55%). Mediastinal lesions were observed in 8 cases (20%), including mediastinal hematoma in 3 cases (7.5%), hemopericardium in 3 (7.5%), and pneumomediastinum in 2 (5%). Diaphragmatic rupture was seen in 2 cases (5%). Conclusion In patients with penetrating thoracic trauma, computed tomography of the chest is an important tool for characterizing the affected organs and evaluating the path of injury, as well as the severity and extent of the lesions. The images obtained are also useful in estimating the risk of death and determining the best therapeutic approach.
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Affiliation(s)
| | - Luiza Beatriz Melo Moreira
- MD, Radiologist at the Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (HUAP-UFF), Niterói, RJ, Brazil
| | | | - Nara Saint-Martin
- MD, Resident at Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (HUAP-UFF), Niterói, RJ, Brazil
| | - Roger Ancilotti Filho
- MD, Resident at Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (HUAP-UFF), Niterói, RJ, Brazil
| | - Arthur Soares Souza
- PhD, MD, Radiologist, Faculdade de Medicina de São José do Rio Preto (Famerp) and Ultra X, São José do Rio Preto, SP, Brazil
| | - Edson Marchiori
- Full Professor at the Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Leite L, Gonçalves L, Nuno Vieira D. Cardiac injuries caused by trauma: Review and case reports. J Forensic Leg Med 2017; 52:30-34. [PMID: 28850860 DOI: 10.1016/j.jflm.2017.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/28/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Abstract
Assessment of suspected cardiac injuries in a trauma setting is a challenging and time-critical matter, with clinical and imaging findings having complementary roles in the formation of an accurate diagnosis. In this article, we review the supporting literature for the pathophysiology, classification and evaluation of cardiac injuries caused by trauma. We also describe 4 cardiac trauma patients seen at a tertiary referral hospital.
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Affiliation(s)
- Luís Leite
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Department of Cardiology, Coimbra Hospital and University Center, Coimbra, Portugal.
| | - Lino Gonçalves
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Department of Cardiology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - Duarte Nuno Vieira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal; National Institute of Legal Medicine and Forensic Sciences, Coimbra, Portugal
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Murphy DJ, Gill RR. Overview of treatment related complications in malignant pleural mesothelioma. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:235. [PMID: 28706903 DOI: 10.21037/atm.2017.03.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive malignant neoplasm of the pleura related to asbestos exposure. Despite recent advances in therapy for MPM, the prognosis remains poor, with considerable treatment associated morbidity. Radiological assessment plays a central role in the timely identification and subsequent management of treatment related complications in MPM. This review highlights common and uncommon complications associated with and encountered in the post treatment phase.
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Affiliation(s)
- David J Murphy
- Division of Thoracic Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ritu R Gill
- Division of Thoracic Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Lee TL, Hsuan CF, Shih CH, Liang HW, Tsai HS, Tseng WK, Hsu KL. Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report. BMC Cardiovasc Disord 2017; 17:56. [PMID: 28183285 PMCID: PMC5301382 DOI: 10.1186/s12872-017-0496-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Case presentation Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Conclusion Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.
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Affiliation(s)
- Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Chen-Hsiang Shih
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Huai-Wen Liang
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Hsing-Shan Tsai
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan
| | - Wei-Kung Tseng
- Division of Cardiology, Department of Internal Medicine, E-Da hospital / I-Shou University, Kaohsiung, Taiwan.
| | - Kwan-Lih Hsu
- Department of Internal Medicine, E-Da cancer hospital / I-Shou University, Kaohsiung, Taiwan
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The Feasibility of Dual-Energy Computed Tomography in Cardiac Contusion Imaging for Mildest Blunt Cardiac Injury. J Comput Assist Tomogr 2017; 41:354-359. [DOI: 10.1097/rct.0000000000000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Anninos H, Baikoussis NG, Dedeilias P, Argiriou M, Politis P, Gounopoulos P, Koroneos A, Charitos C. Simultaneous "traumatic Gerbode" and aortic rupture due to blunt chest trauma. Ann Card Anaesth 2016; 19:182-7. [PMID: 26750699 PMCID: PMC4900402 DOI: 10.4103/0971-9784.173045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The Gerbode defect is characterized by a perimembranous ventricular septal defect between the left ventricle and the right atrium. This intracardiac shunt is a congenital defect but may be iatrogenic after valve surgery or atrioventricular node ablation, may be the result of endocarditis or may be traumatic. It is really rarely encountered as sequelae of non-penetrating heart trauma, and their clinical manifestations may often be unrecognized in the multi-injured patient. However, they are serious complications, and their diagnostic approach is not always feasible. We hereby present a case of a young man with the left ventricle to the right atrium communication after blunt thoracic trauma due to a car accident and concomitant rupture of the thoracic aorta. We present also the case and the ways of treatment according to the international bibliography.
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Affiliation(s)
| | - Nikolaos G Baikoussis
- Department of Cardiovascular and Thoracic Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece
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Traumatic Cardiac Injury: Ventricular Perforation Caught on CT. Case Rep Radiol 2016; 2016:9696107. [PMID: 27382496 PMCID: PMC4921143 DOI: 10.1155/2016/9696107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/16/2016] [Indexed: 11/17/2022] Open
Abstract
Myocardial rupture is a rare imaging diagnosis given its clinical severity and high mortality. Early findings should be promptly communicated to the trauma service to ensure immediate intervention. We present a rare case of blowout perforation of the right ventricle which was prospectively diagnosed on computed tomography (CT) leading to emergent operative repair. The patient subsequently survived and was discharged after a lengthy hospital course.
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Zeidenberg J, Durso AM, Caban K, Munera F. Imaging of Penetrating Torso Trauma. Semin Roentgenol 2016; 51:239-55. [DOI: 10.1053/j.ro.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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38
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Hsu MJ, Gupta A, Soto JA, LeBedis CA. Imaging of Torso and Extremity Vascular Trauma. Semin Roentgenol 2016; 51:165-79. [DOI: 10.1053/j.ro.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- Sreevathsan Sridhar
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO.
| | - Constantine Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO
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Hammer MM, Raptis DA, Cummings KW, Mellnick VM, Bhalla S, Schuerer DJ, Raptis CA. Imaging in blunt cardiac injury: Computed tomographic findings in cardiac contusion and associated injuries. Injury 2016; 47:1025-30. [PMID: 26646729 DOI: 10.1016/j.injury.2015.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/08/2015] [Accepted: 11/05/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Blunt cardiac injury (BCI) may manifest as cardiac contusion or, more rarely, as pericardial or myocardial rupture. Computed tomography (CT) is performed in the vast majority of blunt trauma patients, but the imaging features of cardiac contusion are not well described. PURPOSE To evaluate CT findings and associated injuries in patients with clinically diagnosed BCI. MATERIALS AND METHODS We identified 42 patients with blunt cardiac injury from our institution's electronic medical record. Clinical parameters, echocardiography results, and laboratory tests were recorded. Two blinded reviewers analyzed chest CTs performed in these patients for myocardial hypoenhancement and associated injuries. RESULTS CT findings of severe thoracic trauma are commonly present in patients with severe BCI; 82% of patients with ECG, cardiac enzyme, and echocardiographic evidence of BCI had abnormalities of the heart or pericardium on CT; 73% had anterior rib fractures, and 64% had pulmonary contusions. Sternal fractures were only seen in 36% of such patients. However, myocardial hypoenhancement on CT is poorly sensitive for those patients with cardiac contusion: 0% of right ventricular contusions and 22% of left ventricular contusions seen on echocardiography were identified on CT. CONCLUSION CT signs of severe thoracic trauma are frequently present in patients with severe BCI and should be regarded as indirect evidence of potential BCI. Direct CT findings of myocardial contusion, i.e. myocardial hypoenhancement, are poorly sensitive and should not be used as a screening tool. However, some left ventricular contusions can be seen on CT, and these patients could undergo echocardiography or cardiac MRI to evaluate for wall motion abnormalities.
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Affiliation(s)
- Mark M Hammer
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States.
| | - Demetrios A Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States.
| | | | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States.
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States.
| | - Douglas J Schuerer
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States.
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States.
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[Imaging of blunt chest trauma]. Radiologe 2015; 54:886-92. [PMID: 25116049 DOI: 10.1007/s00117-013-2637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. STANDARD RADIOLOGICAL METHODS Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. METHODOLOGICAL INNOVATIONS Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. PRACTICAL RECOMMENDATIONS In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients.
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Shergill AK, Maraj T, Barszczyk MS, Cheung H, Singh N, Zavodni AE. Identification of Cardiac and Aortic Injuries in Trauma with Multi-detector Computed Tomography. J Clin Imaging Sci 2015; 5:48. [PMID: 26430541 PMCID: PMC4584444 DOI: 10.4103/2156-7514.163992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/02/2015] [Indexed: 11/04/2022] Open
Abstract
Blunt and penetrating cardiovascular (CV) injuries are associated with a high morbidity and mortality. Rapid detection of these injuries in trauma is critical for patient survival. The advent of multi-detector computed tomography (MDCT) has led to increased detection of CV injuries during rapid comprehensive scanning of stabilized major trauma patients. MDCT has the ability to acquire images with a higher temporal and spatial resolution, as well as the capability to create multiplanar reformats. This pictorial review illustrates several common and life-threatening traumatic CV injuries from a regional trauma center.
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Affiliation(s)
- Arvind K Shergill
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Tishan Maraj
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Barszczyk
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Helen Cheung
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Navneet Singh
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Anna E Zavodni
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
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Voskresenskij OV, Radchenko YA, Abakumov MM. [Possibilities of videothoracoscopy for penetrating thoracic injuries]. Khirurgiia (Mosk) 2015:20-26. [PMID: 26271560 DOI: 10.17116/hirurgia2015720-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It was analyzed the medical reports of 596 victims with thoracic injuries including 360 cases with following conventional therapeutic approach and 236 patients who underwent videothoracoscopy. We estimated condition severity in case of injuries of thoracic wall, lungs, pericardium and heart. Hemodynamic disorders were estimated according to Allgower-Burri shock index. Intrapleural bleeding was calculated using volume of hemothorax and time before injury and operation. Severity of physiological damages was determined using RTS criterion, anatomic--using ISS criterion. We estimated possibility for videothoracoscopy in patients with conventional therapeutic approach comparing severity of injuries, severity of condition in both groups and volume of surgery. Retrospective analysis revealed possibility of videothoracoscopy in 86.7% of victims with pulmonary injury, in 83.3% with bleeding at the muscular vessels of thoracic wall, in 40.3% with intercostal vessels injury, in 31.2% with heart injury, in 27.3% with damage of pericardium and in 18.8% with internal thoracic vessels injury. Our investigation revealed that videothoracoscopy may be used more widely in case of thoracic injury.
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Affiliation(s)
- O V Voskresenskij
- Department of Emergency Thoracoabdominal Surgery, Department of Health, Moscow, Russia
| | - Yu A Radchenko
- Department of Emergency Thoracoabdominal Surgery, Department of Health, Moscow, Russia
| | - M M Abakumov
- Department of Emergency Thoracoabdominal Surgery, Department of Health, Moscow, Russia
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Abstract
This article discusses the role of radiology in evaluating patients with penetrating injuries to the chest. Penetrating injuries to the chest encompass ballistic and nonballistic injuries and can involve superficial soft tissues of the chest wall, lungs and pleura, diaphragm, and mediastinum. The mechanism of injury in ballistic and nonballistic trauma and the impact the injury trajectory has on imaging evaluation of penetrating injuries to the chest are discussed. The article presents the broad spectrum of imaging findings a radiologist encounters with penetrating injuries to the chest, with emphasis on injuries to the lungs and pleura, diaphragm, and mediastinum.
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Affiliation(s)
- Anthony M Durso
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami Miller School of Medicine, 1611 Northwest, 12th Avenue, WW-279, Miami, FL 33136, USA
| | - Kim Caban
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami Miller School of Medicine, 1611 Northwest, 12th Avenue, WW-279, Miami, FL 33136, USA
| | - Felipe Munera
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, Radiology Services, University of Miami Hospitals, University of Miami Miller School of Medicine, 1611 Northwest, 12th Avenue, WW-279, Miami, FL 33136, USA.
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Nagpal P, Saboo SS, Khandelwal A, Duran-Mendicuti MA, Abbara S, Steigner ML. Traumatic right atrial pseudoaneurysm. Cardiovasc Diagn Ther 2015; 5:141-4. [PMID: 25984454 DOI: 10.3978/j.issn.2223-3652.2015.01.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/05/2015] [Indexed: 11/14/2022]
Abstract
Pseudoaneurysm is defined as contained blood pooling due to rupture of vascular wall. They have higher risk of rupture and hence are usually managed aggressively. Trauma, infection and prior surgery are the most common etiologies for pseudoaneurysm of most sites. Traumatic cardiac pseudoaneurysm are rare and poses a diagnostic challenge to the treating physician since there is no specific symptoms associated with pseudoaneurysm and electrocardiogram; cardiac enzymes and echocardiogram may be unrevealing or inconclusive in many cases. Cross-sectional imaging [computed tomography (CT) and magnetic resonance imaging (MRI)] is done in cases with high index of suspicion and is the standard modality for diagnosis for cardiac pseudoaneurysm. We present a case of conservatively managed post-traumatic right atrial pseudoaneurysm with aim to highlight the role of electrocardiography (ECG)-gated multidetector computed tomography (MDCT) in diagnosis and follow-up of this rare entity that ultimately underwent rapid partial thrombosis.
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Affiliation(s)
- Prashant Nagpal
- 1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; 2 Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA ; 3 Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sachin S Saboo
- 1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; 2 Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA ; 3 Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ashish Khandelwal
- 1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; 2 Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA ; 3 Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
| | - Maria Alejandra Duran-Mendicuti
- 1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; 2 Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA ; 3 Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
| | - Suhny Abbara
- 1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; 2 Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA ; 3 Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
| | - Michael L Steigner
- 1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; 2 Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA ; 3 Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, TX, USA
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Kittaka H, Yagi Y, Zushi R, Hazui H, Akimoto H. Combination of blunt cardiac and pericardial injury presenting a massive hemothorax without hemopericardium. Acute Med Surg 2015; 2:257-259. [PMID: 29123734 DOI: 10.1002/ams2.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/24/2014] [Indexed: 11/11/2022] Open
Abstract
Case A 64-year-old man was injured after falling from a height of 5 m and was transported to our institution. On presentation, his hemodynamic state was unstable, and both focused assessment with sonography for trauma and enhanced computed tomography imaging revealed massive left pleural effusion, but no pericardial effusion. He went into cardiopulmonary arrest just before surgery, so an urgent left anterolateral thoracotomy followed by open chest cardiac massage and aortic clamping were carried out. By performing an additional right anterior thoracotomy, a left pleuropericardial laceration and a perforation measuring 1 cm in diameter at the left ventricle were found. The patient's dynamic state stabilized following the restoration of hemostasis by suturing the rupture site. Outcome The patient's postoperative course was favorable, and he was discharged after 20 days of hospitalization. Conclusion Blunt cardiac and pericardial injury rarely causes massive hemothorax with no hemopericardium, resulting in hemorrhagic shock.
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Affiliation(s)
- Hirotada Kittaka
- Department of Emergency Osaka Mishima Emergency Critical Care Center Takatsuki City Japan
| | - Yoshiki Yagi
- Department of Emergency Osaka Mishima Emergency Critical Care Center Takatsuki City Japan
| | - Ryosuke Zushi
- Department of Emergency Osaka Mishima Emergency Critical Care Center Takatsuki City Japan
| | - Hiroshi Hazui
- Department of Emergency Osaka Mishima Emergency Critical Care Center Takatsuki City Japan
| | - Hiroshi Akimoto
- Department of Emergency Osaka Mishima Emergency Critical Care Center Takatsuki City Japan
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Radomski M, Zettervall S, Schroeder ME, Messing J, Dunne J, Sarani B. Critical Care for the Patient With Multiple Trauma. J Intensive Care Med 2015; 31:307-18. [PMID: 25673631 DOI: 10.1177/0885066615571895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023]
Abstract
Trauma remains the leading cause of death worldwide and the leading cause of death in those less than 44 years old in the United States. Admission to a verified trauma center has been shown to decrease mortality following a major injury. This decrease in mortality has been a direct result of improvements in the initial evaluation and resuscitation from injury as well as continued advances in critical care. As such, it is vital that intensive care practitioners be familiar with various types of injuries and their associated treatment strategies as well as their potential complications in order to minimize the morbidity and mortality frequently seen in this patient population.
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Affiliation(s)
- Michal Radomski
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Sara Zettervall
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Mary Elizabeth Schroeder
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Jonathan Messing
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - James Dunne
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
| | - Babak Sarani
- Department of Surgery, Center for Trauma and Critical Care (CTACC), George Washington University, Washington, DC, USA
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Reginelli A, Russo A, Maresca D, Martiniello C, Cappabianca S, Brunese L. Imaging assessment of gunshot wounds. Semin Ultrasound CT MR 2014; 36:57-67. [PMID: 25639178 DOI: 10.1053/j.sult.2014.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Gunshot injuries occur when someone is shot by a bullet or other sort of projectile from a firearm. Wounds are generally classified as low velocity (less than 609.6m/s) or high velocity (more than 609.6m/s). Those with higher velocity may be expected, on this basis, to dissipate more energy into surrounding tissue as they are slow and cause more tissue damage, but this is only a very approximate guide. However, these terms can be misleading; more important than velocity is the efficiency of energy transfer, which is dependent on the physical characteristics of the projectile, as well as the kinetic energy, stability, entrance profile and path traveled through the body, and the biological characteristics of the tissues injured. Hemodynamically stable patients and patients who stabilized after simple immediate resuscitation were evaluated with a careful history and physical examination. A routine x-ray is performed in patients with gunshot wounds. Indication for total body computed tomography (CT) is based on the presence of signs and symptoms of vascular damage at clinical examination. Patients are immediately transferred in the operating room for surgery if more serious injuries that require immediate surgical care are not diagnosed, or hemostasis may be preliminary reached in the emergency room. Hemodynamically stable patients with no history and clinical examination showing suspected vascular damage are allowed in the radiology department for obtaining a total body CT scan with intravenous contrast medium and then transferred to the surgical ward trauma for observation. After 24 hours without the complications, patient can be discharged. CT is the procedure of choice to identify hemorrhage, air, bullet, bone fragments, hemothorax, nerve lesion, musculoskeletal lesions, and vessels injuries and is useful for assessing medicolegal aspects as trajectory and the anatomical structures at risk.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy.
| | - Anna Russo
- Department of Radiology, S. G. Moscati Hospital, Aversa, Italy
| | - Duilia Maresca
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | | | - Salvatore Cappabianca
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy
| | - Luca Brunese
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Second University of Naples, Naples, Italy; Department of Health Science, University of Molise, Campobasso, Italy
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