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Kumar A, Shiwalkar N, Bhate S, Keshavamurthy S. Management of Thoracic and Cardiac Trauma: A Case Series and Literature Review. Cureus 2022; 14:e26465. [PMID: 35800197 PMCID: PMC9246353 DOI: 10.7759/cureus.26465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
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Kodikara S, Siddique S, Wickramasinghe C. Self-induced hemopericardium using a syringe needle: A rare method of suicide. Leg Med (Tokyo) 2022; 54:102005. [PMID: 34991039 DOI: 10.1016/j.legalmed.2021.102005] [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: 06/04/2021] [Revised: 11/25/2021] [Accepted: 12/18/2021] [Indexed: 11/30/2022]
Abstract
This communication highlights a rare case of suicide by self-induced hemopericardium caused by a penetrating syringe needle. A 20-year-old male, diagnosed with ulcerative colitis, severe depression and hypochondriasis, was found dead at home. There was a 23-gauge 3 cm long syringe needle, connected to a 3 cc barrel, penetrating the left side of the chest. Autopsy revealed 3 fresh puncture marks on the left side of the anterior chest with subcutaneous hemorrhage underlying the puncture marks. The needle had penetrated through the 4th intercoastal space and entered the pericardial cavity causing superficial lacerations to the anterior wall of the heart. There were two anterior pericardial perforations. A hemopericardium of 235 ml was noted. Interventricular septal branches arising from the lower half of the left anterior descending artery were lacerated. Microscopy revealed multiple fresh hemorrhages into the myocardium at the site of myocardial injuries. Toxicological analysis of blood, urine and swabs from the syringe barrel was negative. The cause of death was given as hemopericardium due to laceration of the interventricular septal branches of the left anterior descending artery due to penetration by a 23-gauge syringe needle. The circumstance was concluded as suicidal. Suicide by stab to the chest using a 23-gauge syringe needle, resulting in hemopericardium where the source of blood was the coronary artery, has not been reported in the medical literature. A forensic pathologist must be vigilant and cautious in the interpretation of similar findings especially when cardiopulmonary resuscitation and/or therapeutic intracardiac injections have been administered.
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Affiliation(s)
- Sarathchandra Kodikara
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.
| | - Sadik Siddique
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Shah NN, Kay B, Jiang NM, Chun HJ. Collateral Damage: Gun Violence-Induced STEMI. JACC Case Rep 2021; 3:20-25. [PMID: 34317462 PMCID: PMC8305673 DOI: 10.1016/j.jaccas.2020.09.060] [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: 06/11/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
A young man who presented with chest trauma from multiple gunshot wounds was found to have regional ST-segment elevations perioperatively. This case describes the rapid evaluation and clinical management by a multidisciplinary consultative team pursued for this unusual presentation of cardiac injury. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Nimish N Shah
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bradley Kay
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nona M Jiang
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hyung J Chun
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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4
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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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5
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Fatal delayed hemopericardium and hemothorax following blunt chest trauma. Forensic Sci Med Pathol 2019; 15:272-275. [DOI: 10.1007/s12024-018-0069-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 11/26/2022]
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Saranteas T, Mavrogenis AF, Mandila C, Poularas J, Panou F. Ultrasound in cardiac trauma. J Crit Care 2016; 38:144-151. [PMID: 27907878 DOI: 10.1016/j.jcrc.2016.10.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/31/2016] [Indexed: 11/17/2022]
Abstract
In the perioperative period, the emergency department or the intensive care unit accurate assessment of variable chest pain requires meticulous knowledge, diagnostic skills, and suitable usage of various diagnostic modalities. In addition, in polytrauma patients, cardiac injury including aortic dissection, pulmonary embolism, acute myocardial infarction, and pericardial effusion should be immediately revealed and treated. In these patients, arrhythmias, mainly tachycardia, cardiac murmurs, or hypotension must alert physicians to suspect cardiovascular trauma, which would potentially be life threatening. Ultrasound of the heart using transthoracic and transesophageal echocardiography are valuable diagnostic tools that can be used interchangeably in conjunction with other modalities such as the electrocardiogram and computed tomography for the diagnosis of cardiovascular abnormalities in trauma patients. Although ultrasound of the heart is often underused in the setting of trauma, it does have the advantages of being easily accessible, noninvasive, and rapid bedside assessment tool. This review article aims to analyze the potential cardiac injuries in trauma patients, and to provide an elaborate description of the role of echocardiography for their accurate diagnosis.
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Affiliation(s)
- Theodosios Saranteas
- Department of Anaesthesiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Christina Mandila
- Intensive Care Unit, General State Hospital of Athens, Athens, Greece
| | - John Poularas
- Intensive Care Unit, General State Hospital of Athens, Athens, Greece
| | - Fotios Panou
- Second department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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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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Dawson J, Rodriguez Y, Pham SM, Ferreira A. Traumatic transection of the left anterior descending artery caused by a projectile. J Cardiol Cases 2012; 5:e140-e142. [DOI: 10.1016/j.jccase.2012.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/27/2012] [Accepted: 02/08/2012] [Indexed: 11/16/2022] Open
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Wenhua D, Xiuqin X, Weimin Z. Doppler tissue energy and stress echocardiography in the diagnosis of myocardial contusion in canines. Cell Biochem Biophys 2011; 62:383-9. [PMID: 22065256 DOI: 10.1007/s12013-011-9311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We sought to evaluate the significance of Doppler tissue energy (DTE) and stressed echocardiography for diagnosing myocardial contusion (MC) in canines. Ten adult healthy dogs were anesthetized (3% pentobarbital sodium/i.v.) and impacted by BIM-II biological impact machine to induce MC. Conventional and stressed echocardiographies were used for segmental abnormal ventricular wall motions; DTE was also used to detect the abnormal ventricular wall motions and areas of injured myocardial fibers after MC, and the results were compared with those of triphenyl tetrazolium chloride (TTC) staining. The data show that both conventional and stressed echocardiographies identified ventricular wall segmental abnormal motions or even aneurysms. These segments were mainly distributed over the front and middle interventricular walls and anterolateral ventricular wall. The ventricular wall motion scoring and wall motion segment index (WMSI) increased remarkably after MC induction. Compared with TTC staining, the conventional echocardiography showed 100% sensitivity and 66.67% specificity, whereas the stressed echocardiography displayed 100% sensitivity and 88.89% specificity. DTE showed both the sensitivity and specificity of 100% for MC diagnosis. Thus, DTE has higher specificity than conventional and stressed echocardiographies. In conclusion, both DTE and stress echocardiography have higher clinical value for MC diagnosis in canines.
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Affiliation(s)
- Du Wenhua
- Department of Ultrasound, Daping Hospital and Research Institute of Surgery, The Third Military Medical University, Chongqing 40042, China
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Du W, Xiong X, Yang W, Wang X, Li T. Dobutamine stress echocardiography assessment of myocardial contusion due to blunt impact in dogs. Cell Biochem Biophys 2011; 62:169-75. [PMID: 21910029 DOI: 10.1007/s12013-011-9278-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We sought to investigate the role of two-dimensional stress echocardiography in the early assessment of myocardial contusion. For this purpose, 12 dogs, weighing 11.36 ± 1.50 kg, were selected and the myocardial contusion was experimentally induced. Two-dimensional dobutamine stress echocardiography (DSE) was used to detect abnormal myocardial motions segments at time phases of baseline and 0.5, 2, 4, and 8 h post-wounding. Finally, the above results were compared with pathological findings. The data show that after the dogs were induced to have severe myocardial contusion, 122 segments were found with abnormal myocardial wall motions at 0.5 h post-wounding, 133 segments at 2 h post-wounding, and 142 segments, each, at 4 h and 8 h post-wounding. The wall motion score (WMS) and wall motion score index (WMSI) increased (P < 0.001) as compared with the pre-impaction values. Considering the left ventricular axis view as the standard section, in the 60 segments examined by echocardiography, 54 segments were found to have wall motion abnormalities. Comparing with the results of pathological TTC staining, the sensitivity and specificity were found to be 100 and 66.6%, respectively. It was, therefore, concluded that two-dimensional DSE was a valuable technique in the early diagnosis of myocardial contusion due to its better sensitivity and specificity.
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Affiliation(s)
- WenHua Du
- Department of Ultrasound, Daping Hospital & Research Institute of Surgery, The Military Medical University, Chongqing, China
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Ismailov RM, Ness RB, Redmond CK, Talbott EO, Weiss HB. Trauma Associated With Cardiac Dysrhythmias: Results From a Large Matched Case-Control Study. ACTA ACUST UNITED AC 2007; 62:1186-91. [PMID: 17495723 DOI: 10.1097/01.ta.0000215414.35222.bb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Various cardiac dysrhythmias such as supraventricular and ventricular premature beats, supraventricular and ventricular paroxysmal tachycardia, atrial and ventricular fibrillation and atrial flutter have been reported in case series, as complications of blunt cardiac and thoracic trauma. The objective of this research was to determine whether thoracic or blunt cardiac injury is associated with cardiac dysrhythmia in a large multistate hospitalized population. METHODS Cases and matched (by age) controls were identified based on hospital discharge information that was collected from 986 acute general hospitals across 33 states in 2001. Both the exposure (thoracic trauma and blunt cardiac injury) and the outcome (cardiac dysrhythmias) were identified based on ICD-9-CM discharge diagnoses. Unadjusted and conditional adjusted (for gender, race, length of stay, and primary source of payment) multivariate logistic regression analyses were performed. RESULTS After adjusting for potential confounders, patients 50 years and younger diagnosed with blunt cardiac injury had a fourfold (95% confidence interval, 1.40-11.60) increase in the risk of cardiac dysrhythmia. Independent of potential confounding factors, discharge for blunt cardiac injury among patients 51 to 70 years old was associated with a twofold (95% confidence interval, 1.36-3.82) increased risk for cardiac dysrhythmia. CONCLUSION Blunt cardiac injury was found to be a significant risk factor for cardiac dysrhythmia. Longitudinal studies are needed to better establish the association between trauma and cardiac dysrhythmias.
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Affiliation(s)
- Rovshan M Ismailov
- Bio Med Center for Population Health and Clinic Epidemiology, Brown University, Providence, RI 02940, USA.
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Gavelli G, Napoli G, Bertaccini P, Battista G, Fattori R. Imaging of Thoracic Injuries. Emerg Radiol 2007. [DOI: 10.1007/978-3-540-68908-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Thorax injuries may be divided etiologically into blunt and penetrating types, depending on the nature of the insult. In European practice, the former predominates by far, and in only about 5% of cases thoracotomy provides the necessary thorax drainage. Morbidity in this type of injury typically involves concomitant lung contusion, sometimes with fatal acute respiratory distress syndrome. In these cases, special ventilation forms, optimal reduction of pain, and organ replacement are the decisive therapeutic methods. In contrast, about 80% of penetrating trauma to the thorax require prompt transpleural or trans-sternal surgery, depending on the type of injury. Emergency first aid must follow the principle of "scoop and run". Each minute elapsed until emergent thoracotomy can be decisive to survival in these cases, and the fastest possible transport from the place of injury takes priority over time-consuming stabilization.
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Affiliation(s)
- H Schelzig
- Universitätsklinik für Thorax- und Gefässchirurgie, Universität Ulm.
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15
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Izgi A, Futbolcu H, Kirma C, Mansuroglu D, Tanalp AC. Iatrogenic Coronary Artery Stenosis and Late Ventricular Septal Defect After Penetrating Cardiac Trauma Repair. J Card Surg 2006; 21:284-5. [PMID: 16684063 DOI: 10.1111/j.1540-8191.2005.00126.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report herein a 20-year-old male who has apical myocardial infarction due to suturing of the distal left anterior descending artery and late ventricular septal defect after penetrating cardiac trauma repair.
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Affiliation(s)
- Akin Izgi
- Cardiology, Kosuyoly Heart Education and Research Hospital, Istanbul, Turkey.
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Heldmann MG, Martin AK, Hebert J, Nawabi A, Mandapati D. Localization of Missile Tract and Intrapericardial Foreign Body with Computed Tomography: Case Report and Review of the Literature. ACTA ACUST UNITED AC 2006; 60:410-3. [PMID: 16508506 DOI: 10.1097/01.ta.0000204416.33554.0b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maureen G Heldmann
- Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA.
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Ismailov RM, Ness RB, Weiss HB, Lawrence BA, Miller TR. Trauma associated with acute myocardial infarction in a multi-state hospitalized population. Int J Cardiol 2006; 105:141-6. [PMID: 16243104 DOI: 10.1016/j.ijcard.2004.11.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2004] [Accepted: 11/13/2004] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Trauma has been suggested, in case series, as one of the nonatherosclerotic mechanisms leading to acute myocardial infarction (AMI), the leading cause of death in the US. AMI following non-penetrating injury has been shown to carry significant morbidity and mortality. OBJECTIVE To determine whether hospitalized injuries in a large multi state population are associated with increased risk of AMI during the initial hospital stay. METHODS Statewide injury hospital discharge data were collected from 19 states in 1997. Affected body regions of interest included thoracic, abdominal or pelvic, spine or back and blunt cardiac injury (BCI). The outcome of interest was AMI which was identified based on ICD-9-CM discharge diagnoses for the same visit. Unadjusted and adjusted multivariate logistic regression analyses were performed. RESULTS Independent of confounding factors and coronary arteriography (CA) status, BCI was associated with 2.6-fold increased risk for AMI in persons 46 years or older. When the diagnosis of AMI was confirmed by CA, BCI was associated with 8-fold risk elevation among patients 46 years and older and a 31-fold elevation among patients 45 years and younger. Abdominal or pelvic trauma, irrespective of confounding factors and CA status, was associated with a 65% increase in the risk of AMI among patients 45 years and younger and 93% increase in the risk of among patients 46 years and older. When the diagnosis of AMI was confirmed by CA, abdominal or pelvic trauma was associated with 6-fold risk elevation among patients 46 years and older. CONCLUSION Direct trauma to the heart, as characterized by a diagnosis of BCI, was observed to carry the greatest risk for AMI. Abdominal or pelvic trauma also increased the risk for AMI. Longitudinal studies are warranted to better understand the relationship between trauma and AMI.
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Affiliation(s)
- Rovshan M Ismailov
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, P.O. Box 19122, Pittsburgh, PA 15213, USA.
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Rajan GP, Zellweger R. Cardiac Troponin I as a Predictor of Arrhythmia and Ventricular Dysfunction in Trauma Patients With Myocardial Contusion. ACTA ACUST UNITED AC 2004; 57:801-8; discussion 808. [PMID: 15514534 DOI: 10.1097/01.ta.0000135157.93649.72] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial contusion during blunt chest trauma is common and may lead to potentially fatal cardiac complications. Therefore, it is useful to identify a serum marker reflecting the myocardial damage that can predict risk for cardiac complications. In this study, the authors determined the strength of the association between cardiac troponin I (cTnI) levels and the risk of arrhythmia or the development of left ventricular dysfunction in a cohort of patients with blunt chest trauma. METHODS AND RESULTS In 187 multiply injured patients with blunt chest trauma, serial measurements of cTnI, total creatine kinase (CK), and isoenzyme of creatine kinase with muscle and brain subunits (CK-MB) were combined with sequential electrocardigraphic and echocardiographic recordings. The results showed that 63 patients (34%) had myocardial contusion, as defined by positive cTnI levels, of which 47 (25%) were symptomatic and 16 (9%) showed no abnormalities. The remaining 124 patients (66%) displaying negative CTnI levels were asymptomatic during the entire study. Severity of arrhythmia correlated directly with increase in cTnI levels. The levels of cTnI in the symptomatic group remained elevated significantly longer than the levels in the asymptomatic group. The depression of left ventricular ejection fraction was inversely correlated with the increase in cTn levels. The patients whose cTnI levels were below 1.05 microg/L at admission and during the first 6 hours afterward showed no cardiac abnormalities throughout the entire study period CONCLUSIONS Levels of cTnI below 1.05 microg/L in asymptomatic patients at admission and within the first 6 hours after admission rule out myocardial injury, whereas positive cTn levels above 1.05 microg/L mandate further cardiologic workup for the detection and management of myocardial injury. Furthermore, the dynamics and peak levels of pathologic cTnI levels allow estimation of arrhythmia risk and left ventricular dysfunction in trauma patients with myocardial contusion.
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Affiliation(s)
- Gunesh P Rajan
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
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Bernardis V, Kette F, Blarasin L, Pegoraro C, Coassin R. Isolated myocardial contusion in blunt chest trauma. Eur J Emerg Med 2004; 11:287-90. [PMID: 15359204 DOI: 10.1097/00063110-200410000-00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this case report was to document a rare case of isolated myocardial contusion in the setting of blunt thoracic trauma. Although demonstrated by electrocardiogram and myocardium-specific enzymes, the trauma had no clinical relevance and the patient was discharged uneventfully from the intensive care unit. The clinical significance of blunt myocardial contusion is then discussed.
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Affiliation(s)
- Valentina Bernardis
- Department of Emergency Medicine, San Vito al Tagliamento Hospital, San Vito al Tagliamento (PN), Italy
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20
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Tayal VS, Beatty MA, Marx JA, Tomaszewski CA, Thomason MH. FAST (focused assessment with sonography in trauma) accurate for cardiac and intraperitoneal injury in penetrating anterior chest trauma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:467-472. [PMID: 15098863 DOI: 10.7863/jum.2004.23.4.467] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the FAST (focused assessment with sonography in trauma) examination for determining traumatic pericardial effusion and intraperitoneal fluid indicative of injury in patients with penetrating anterior chest trauma. METHODS An observational prospective study was conducted over a 30-month period at an urban level I trauma center. FAST was performed in the emergency department by emergency physicians and trauma surgeons. FAST results were recorded before review of patient outcome as determined by 1 or more of the following: thoracotomy, laparotomy, pericardial window, cardiologic echocardiography, diagnostic peritoneal lavage, computed tomography, and serial examinations. RESULTS FAST was undertaken in 32 patients with penetrating anterior chest trauma: 20 (65%) had stab wounds, and 12 (35%) had gunshot wounds. Sensitivity of FAST for cardiac injury (n = 8) in patients with pericardial effusion was 100% (95% confidence interval, 63.1%-100%); specificity was 100% (95% confidence interval, 85.8%-100%). The presence of pericardial effusion determined by FAST correlated with the need for thoracotomy in 7 (87.5%) of 8 patients (95% confidence interval, 47.3%-99.7%). One patient with a pericardial blood clot on cardiologic echocardiography was treated nonsurgically. FAST had 100% sensitivity for intraperitoneal injury (95% confidence interval, 63.1%-100%) in 8 patients with views indicating intraperitoneal fluid but without pericardial effusion, again with no false-positive results, giving a specificity of 100% (95% confidence interval, 85.8%-100%). This prompted necessary laparotomy in all 8. CONCLUSIONS In this series of patients with penetrating anterior chest trauma, the FAST examination was sensitive and specific in the determination of both traumatic pericardial effusion and intraperitoneal fluid indicative of injury, thus effectively guiding emergent surgical decision making.
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Affiliation(s)
- Vivek S Tayal
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
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21
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Abstract
In summary, the incidence of BCI following blunt thoracic trauma patients has been reported between 20% and 76%, and no gold standard exists to diagnose BCI. Diagnostic tests should be limited to identify those patients who are at risk of developing cardiac complications as a result of BCI. Therapeutic interventions should be directed to treat the complications of BCI. Finally, the prognosis and outcome of BCI patients is encouraging
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Affiliation(s)
- Jess M Schultz
- Department of Surgery, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, L223, Portland, OR 97239, USA
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Lomoschitz FM, Eisenhuber E, Linnau KF, Peloschek P, Schoder M, Bankier AA. Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms. Eur J Radiol 2003; 48:61-70. [PMID: 14511861 DOI: 10.1016/s0720-048x(03)00202-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In patients after chest trauma, imaging plays a key role for both, the primary diagnostic work-up, and the secondary assessment of potential treatment. Despite its well-known limitations, the anteroposterior chest radiograph remains the starting point of the imaging work-up. Adjunctive imaging with computed tomography, that recently is increasingly often performed on multidetector computed tomography units, adds essential information not readily available on the conventional radiograph. This allows better definition of trauma-associated thoracic injuries not only in acute traumatic aortic injury, but also in pulmonary, tracheobronchial, cardiac, diaphragmal, and thoracic skeletal injuries. This article reviews common radiographic findings in patients after chest trauma, shows typical imaging features resulting from thoracic injury, presents imaging algorithms, and recalls to the reader less common but clinically relevant entities encountered in patients after thoracic trauma.
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Affiliation(s)
- Fritz M Lomoschitz
- Department of Radiology, University of Vienna Medical School, AKH Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Abstract
The introduction of CT imaging in the 1970s revolutionized all aspects of medical care, perhaps nowhere more so than in the evaluation of acutely injured patients. Just as single-slice helical scanning was a great advance over conventional CT, the capabilities of MSCT are proving to be dramatically superior to single-slice methods. Improved contrast bolus imaging, thinner slices, and isotropic voxels should enable the trauma radiologist to identify both major organ system disruption and subtle injuries more promptly. Multiplanar and three-dimensional reconstructions, a forte of MSCT, facilitate rapid communication of disease states with surgeons and others involved in the care of injured patients. In many centers, whole-body CT is beginning to supplant plain films of the chest and spine in the evaluation of severe trauma victims; the cost-effectiveness of such methods is still under evaluation.
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Affiliation(s)
- Luis A Rivas
- Department of Radiology, University of Miami School of Medicine, Jackson Memorial Hospital, West Wing 279, 1611 Northwest 12th Avenue, Miami, FL 33136, USA
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24
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Hill G, Davies K. Blunt chest trauma: a challenge to accident and emergency nurses. ACCIDENT AND EMERGENCY NURSING 2002; 10:197-204. [PMID: 12568446 DOI: 10.1016/s0965-2302(02)00126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of myocardial contusion as a result of blunt chest trauma remains difficult to assess. As such the potentially lethal consequences are often difficult to mitigate against. The true incidence of myocardial contusion is not known and various authors have ascribed percentages in the very broad range of 8-71% of those having suffered blunt chest trauma. The extremely wide variation in presenting signs and symptoms further complicates the clinical picture creating a complicated and complex challenge for the assessing team. In the absence of clear guidelines to date a number of potential options are discussed exploring their efficacy and appropriateness in the management of those patients suffering from blunt chest trauma.
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Affiliation(s)
- Gaynor Hill
- Sister Coronary Care Unit, Prince Charles Hospital, Merthyr Tydfil, CF47 9DT, UK
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25
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Lawler LP, Fishman EK. Postoperative rupture of the right ventricular free wall with transthoracic leak: multidetector CT findings. J Comput Assist Tomogr 2001; 25:574-6. [PMID: 11473188 DOI: 10.1097/00004728-200107000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Right ventricular free-wall rupture may complicate sternal-splitting operations but may be clinically occult. Awareness of this entity and the CT imaging features may help avert a potentially catastrophic outcome.
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Affiliation(s)
- L P Lawler
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21287, USA
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26
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Sliker CW, Mirvis SE, Shanmuganathan K, Meyer CA. Blunt cardiac rupture: value of contrast-enhanced spiral CT. Clin Radiol 2000; 55:805-8. [PMID: 11052887 DOI: 10.1053/crad.1999.0172] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C W Sliker
- Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA
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27
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Ellis DY, Hutchinson NP. Synchronized direct current cardioversion of atrial fibrillation after blunt chest trauma. THE JOURNAL OF TRAUMA 2000; 49:342-4. [PMID: 10963551 DOI: 10.1097/00005373-200008000-00026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D Y Ellis
- Department of Surgery, Greenwich District Hospital, Vanburgh Hill, London, United Kingdom
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28
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Abstract
In addition to traumatic aortic injuries (TAI), blunt chest trauma may damage other structures in the mediastinum, including the tracheobronchial tree, the heart and pericardium, and rarely the esophagus. Tracheobronchial injuries may be difficult to separate radiographically from accompanying parenchymal lung injuries. Experience with diagnosis by computed tomography (CT) is still limited. Cardiac injuries often require emergent surgery before extensive imaging can be done. Some patients, usually those with chamber ruptures of the right heart, survive long enough to receive a chest CT, at which time hemopericardium can be detected. Upper esophageal injuries may occur in conjunction with lower cervical or upper thoracic spine injures. Distal esophageal injuries are rarely caused by blunt trauma.
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Affiliation(s)
- L Ketai
- Department of Radiology, University of New Mexico, Albuquerque, USA
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29
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Abstract
Chest radiographs remain the initial imaging modality to rapidly screen patients with blunt chest trauma. Spiral CT is more sensitive and specific in diagnosing most thoracic pathology seen in blunt trauma patients. This article reviews the major clinical and radiologic findings that occur with blunt injuries to the chest, excluding mediastinal vascular injuries.
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Affiliation(s)
- K Shanmuganathan
- Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore, USA
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30
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Wildling E, Pusch F, Sator S, Klasen C, Weinstabl C. Management of traumatised patients in the ICU. Anaesthesia 1998; 53 Suppl 2:3-5. [PMID: 9659041 DOI: 10.1111/j.1365-2044.1998.tb15129.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E Wildling
- Department of Anaesthesiology and General Intensive Care, University of Vienna, Austria
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