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Naik Mude N, Prakash S, Shaikh O, Vijayakumar C, Kumbhar U. Traumatic Diaphragmatic Rupture With Pericardial Tear and Transdiaphragmatic Herniation of the Stomach. Cureus 2022; 14:e29473. [DOI: 10.7759/cureus.29473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
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Berrichi S, Bouayed MZ, Amaqdouf S, Abetti A, Berrajaa S, Benaini I, Bkiyar H, Ismaili N, El Ouafi N, Housni B. Delayed cardiac herniation after a traumatic pericardial rupture in a polytrauma patient. Trauma Surg Acute Care Open 2022; 7:e000874. [PMID: 35415270 PMCID: PMC8961166 DOI: 10.1136/tsaco-2021-000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Samia Berrichi
- Anesthesia, Intensive Care, and Resuscitation Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco
| | - Mohamed Zakaria Bouayed
- Anesthesia, Intensive Care, and Resuscitation Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco
| | - Saïda Amaqdouf
- Cardiology Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco
| | - Ayoub Abetti
- Cardiothoracic Surgery Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco
| | - Sara Berrajaa
- Anesthesia, Intensive Care, and Resuscitation Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco
| | - Ilias Benaini
- Anesthesia, Intensive Care, and Resuscitation Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco
| | - Houssam Bkiyar
- Anesthesia, Intensive Care, and Resuscitation Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco.,Simulation Center, Faculty of Medicine and Pharmacy Oujda, Mohammed I University Oujda, Oujda, Oriental, Morocco
| | - Nabila Ismaili
- Cardiology Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco.,Laboratory of Epidemiology, Clinical Research, and Public Health, Faculty of Medicine and Pharmacy Oujda, Mohammed I University Oujda, Oujda, Oriental, Morocco
| | - Noha El Ouafi
- Cardiology Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco.,Laboratory of Epidemiology, Clinical Research, and Public Health, Faculty of Medicine and Pharmacy Oujda, Mohammed I University Oujda, Oujda, Oriental, Morocco
| | - Brahim Housni
- Anesthesia, Intensive Care, and Resuscitation Department, Mohammed VI University Hospital Oujda, Oujda, Oriental, Morocco.,Simulation Center, Faculty of Medicine and Pharmacy Oujda, Mohammed I University Oujda, Oujda, Oriental, Morocco
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Scagliola R, Seitun S, Rosa GM. Cardiac herniation: A practical review in the emergency setting. Am J Emerg Med 2022; 53:222-227. [DOI: 10.1016/j.ajem.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/17/2021] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
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Patel KM, Kumar NS, Desai RG, Mitrev L, Trivedi K, Krishnan S. Blunt Trauma to the Heart: A Review of Pathophysiology and Current Management. J Cardiothorac Vasc Anesth 2021; 36:2707-2718. [PMID: 34840072 DOI: 10.1053/j.jvca.2021.10.018] [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: 08/12/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
Blunt cardiac injury (BCI), defined as an injury to the heart from blunt force trauma, ranges from minor to life-threatening. The majority of BCIs are due to motor vehicle accidents; however, injuries caused by falls, blasts, and sports-related injuries also can be sources of BCI. A significant proportion of patients with BCI do not survive long enough to receive medical care, succumbing to their injuries at the scene of the accident. Additionally, patients with blunt trauma often have coexisting injuries (brain, spine, orthopedic) that can obscure the clinical picture; therefore, a high degree of suspicion often is required to diagnose BCI. Traditionally, hemodynamically stable injuries suspicious for BCI have been evaluated with electrocardiograms and chest radiographs, whereas hemodynamically unstable BCIs have received operative intervention. More recently, computed tomography and echocardiography increasingly have been utilized to identify injuries more rapidly in hemodynamically unstable patients. Transesophageal echocardiography can play an important role in the diagnosis and management of several BCIs that require operative repair. Close communication with the surgical team and access to blood products for potentially massive transfusion also play key roles in maintaining hemodynamic stability. With proper surgical and anesthetic care, survival in cases involving urgent cardiac repair can reach 66%-to-75%. This narrative review focuses on the types of cardiac injuries that are caused by blunt chest trauma, the modalities and techniques currently used to diagnose BCI, and the perioperative management of injuries that require surgical correction.
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Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ.
| | - Nakul S Kumar
- Cardiothoracic and Critical Care Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Ludmil Mitrev
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Keyur Trivedi
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine Pontiac, MI
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Cardiac Outpouchings: Definitions, Differential Diagnosis, and Therapeutic Approach. Cardiol Res Pract 2021; 2021:6792643. [PMID: 34567801 PMCID: PMC8463251 DOI: 10.1155/2021/6792643] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Background and Aims Cardiac outpouchings encounter a series of distinct congenital or acquired entities (i.e. aneurysms, pseudoaneurysms, diverticula, and herniations), whose knowledge is still poorly widespread in clinical practice. This review aims to provide a comprehensive overview focusing on definition, differential diagnosis, and prognostic outcomes of cardiac outpouchings, as well as further insights on therapeutic options, in order to assist physicians in the most appropriate decision-making. Methods The material reviewed was obtained by the following search engines: MEDLINE (PubMed), EMBASE, Google Scholar, and Clinical Trials databases, from January 1966 until March 2021. We searched for the following keywords (in title and/or abstract): (“cardiac” OR “heart”) AND (“outpouching” OR “outpouch” OR “aneurysm” OR “pseudoaneurysm” OR “false aneurysm” OR “diverticulum” OR “herniation”). Review articles, original articles, case series, and case reports with literature review were included in our search. Data from patients with congenital or acquired cardiac outpouchings, from prenatal to geriatric age range, were investigated. Results Out of the 378 papers initially retrieved, 165 duplicates and 84 records in languages other than English were removed. Among the 129 remaining articles, 76 were included in our research material, on the basis of the following inclusion criteria: (a) papers pertaining to the research topic; (b) peer-reviewed articles; (c) using standardized diagnostic criteria; and (d) reporting raw prevalence data. Location, morphologic features, wall motion abnormalities, and tissue characterization were found to have a significant impact in recognition and differential diagnosis of cardiac outpouchings as well as to play a significant role in defining their natural history and prognostic outcomes. Conclusions Careful recognition of cardiac outpouchings remains a diagnostic challenge in clinical practice. Due to a broad cluster of distinctive and heterogeneous entities, their knowledge and timely recognition play a pivotal role in order to provide the most appropriate clinical management and therapeutic approach.
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Kim J, Cho HM, Kim SH, Jung SH, Sohn JE, Lee K. Celiac Artery Compression After a Spine Fracture, and Pericardium Rupture After Blunt Trauma: A Case Report from a Single Injury. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2020.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Mashiko K, Matsumoto H, Yasumatsu H, Ueda T, Yamamoto M, Funaki Y, Toshimitsu Y. Emergent surgery for cardiac herniation coexisting with complex blunt cardiac injury: A case report. Trauma Case Rep 2021; 32:100464. [PMID: 33816745 PMCID: PMC8010855 DOI: 10.1016/j.tcr.2021.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/16/2022] Open
Abstract
A 38-year-old man was pressed on his trunk by a heavy object weighing about 100 kg. The patient was in shock status on arrival to the hospital. Circular collapse progressed rapidly during contrast computed tomography (CT) scanning. CT images revealed exacerbation of the right lateral deviation of the heart that was earlier seen on X-ray imaging. Considering cardiac herniation based on CT findings, we immediately performed resuscitative thoracotomy and clamshell thoracotomy at the emergency department. Intraoperative findings showed a pericardial defect, and the heart had deviated to the right thoracic cavity. Immediate repositioning revealed a marked improvement in circulation. Full-thickness cardiac injury was observed in the anterior wall of the left ventricle; no active bleeding was observed. We performed temporary thoracic wall closure after cardiorraphy for damage control. After admission to the intensive care unit, he presented with respiratory failure associated with pulmonary contusion. Therefore, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was used from the 2nd to the 5th hospital day. After confirming no intra-thoracic events on the 6th hospital day, chest wall closure was performed. The patient subsequently developed heart failure and mitral regurgitation associated with papillary muscle rupture. On the 62nd hospital day, he underwent mitral annuloplasty at the cardiovascular surgery division; After rehabilitation till 152nd hospital day, he was discharged without any neurological abnormality. This was an extremely rare case with concomitant full-thickness myocardial injury, intracardiac injury, and cardiac herniation. Rapid resuscitative thoracotomy and damage control including V-V ECMO yielded good results. Retrospectively, cardiac herniation should have been suspected earlier basis this observation. Our report highlights that cardiac herniation should be considered in case of cardiac shadow aberrations in cases of blunt chest trauma, familiarity with condition and its characteristic imaging findings are critical for the doctor overseeing initial trauma treatment.
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Affiliation(s)
- Kazuki Mashiko
- Shock & Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-city, Chiba 270-1694, Japan
| | - Hisashi Matsumoto
- Shock & Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-city, Chiba 270-1694, Japan
| | - Hiroshi Yasumatsu
- Shock & Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-city, Chiba 270-1694, Japan
| | - Taichiro Ueda
- Shock & Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-city, Chiba 270-1694, Japan
| | - Mariko Yamamoto
- Shock & Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-city, Chiba 270-1694, Japan
| | - Yutaka Funaki
- Shock & Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-city, Chiba 270-1694, Japan
| | - Yasuko Toshimitsu
- Shock & Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-city, Chiba 270-1694, Japan
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Muñoz-Largacha JA, Wei B. Commentary: A prompt diagnosis and timely surgical intervention can improve survival after traumatic cardiac herniation. JTCVS Tech 2020; 4:380-381. [PMID: 34318078 PMCID: PMC8305740 DOI: 10.1016/j.xjtc.2020.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Juan A. Muñoz-Largacha
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Benjamin Wei
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
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LeBlanc N, Tan L. Pericardial rupture with cardiac herniation following blunt thoracic trauma. JTCVS Tech 2020; 4:375-377. [PMID: 34318076 PMCID: PMC8303070 DOI: 10.1016/j.xjtc.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nicholas LeBlanc
- Address for reprints: Nicholas LeBlanc, MD, 175 Emerite Dr, Lafayette, LA 70506.
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Blunt Thoracic Trauma-Induced Mitral Papillary Muscle Avulsion with Pericardial Rupture and Cardiac Herniation: Difficult and Delayed Diagnoses. Case Rep Surg 2020; 2020:3268253. [PMID: 32655965 PMCID: PMC7327572 DOI: 10.1155/2020/3268253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 02/11/2020] [Indexed: 11/18/2022] Open
Abstract
Blunt thoracic trauma (BTT) and the resultant isolated mitral papillary muscle avulsion, pericardial rupture, and cardiac herniation injuries are each rarely diagnosed clinical entities. We describe the first case of combined pericardial tear with cardiac herniation and ruptured mitral papillary muscles following BTT. Preoperative transesophageal echocardiography (TEE) diagnosed the delayed mitral papillary muscle rupture while all previous diagnostic modalities failed to delineate the pericardial rupture and cardiac herniation. Particular emphasis is placed on the clinical and radiologic aspects of the case that would heighten clinical suspicion in the emergency setting where blunt cardiac injury sequelae are suspected and frequently missed.
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11
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Traumatic cardiac dislocation-A case report and review of the literature including a new classification system. J Trauma Acute Care Surg 2020; 87:944-953. [PMID: 31453985 DOI: 10.1097/ta.0000000000002445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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12
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Broughton J, Maguire D, LeBlanc N. Cardiac herniation after blunt thoracic trauma. CMAJ 2020; 192:E454. [PMID: 32392492 DOI: 10.1503/cmaj.191446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Jonathon Broughton
- Departments of Emergency Medicine (Broughton), Anesthesia (Maguire) and Thoracic Surgery (LeBlanc), Rady College of Medicine, University of Manitoba, Winnipeg, Man.
| | - Duncan Maguire
- Departments of Emergency Medicine (Broughton), Anesthesia (Maguire) and Thoracic Surgery (LeBlanc), Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Nicholas LeBlanc
- Departments of Emergency Medicine (Broughton), Anesthesia (Maguire) and Thoracic Surgery (LeBlanc), Rady College of Medicine, University of Manitoba, Winnipeg, Man
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Fadel R, El-Menyar A, ElKafrawy S, Gad MG. Traumatic blunt cardiac injuries: An updated narrative review. Int J Crit Illn Inj Sci 2019; 9:113-119. [PMID: 31620349 PMCID: PMC6792398 DOI: 10.4103/ijciis.ijciis_29_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/23/2019] [Accepted: 08/04/2019] [Indexed: 11/04/2022] Open
Abstract
Blunt cardiac injury (BCI) is defined as injuries sustained due to blunt trauma to the heart, and it remains unchanged for long time. The spectrum of BCI ranges from a minor "bruise" to specific postcontusion cardiac conditions such as free-wall rupture. This is a narrative review provides a continued and updates details regarding BCIs from 2008 to 2017. For this purpose, a narrative review of literature was conducted using appropriate database for retrieval of articles through systematic search methodology. Autopsy-based studies are very limited. It can be concluded that regardless of the variability in the spectrum of modalities and medical/surgical resources, BCIs diagnosis and management remain a puzzle and needs further prospective studies.
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Affiliation(s)
- Rayyan Fadel
- Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.,Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Samir ElKafrawy
- Department of Anesthesia, ElSahel Teaching Hospital, Cairo, Egypt
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Wang D, Zhang F, Meng Y, Yu Y, Zhou K, Sun L, Miao Q, Li D. [Morphological analysis of cardiac rupture due to blunt injury, cardiopulmonary resuscitation and myocardial infarction in forensic pathology]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 38:1514-1520. [PMID: 30613023 DOI: 10.12122/j.issn.1673-4254.2018.12.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the morphological features and forensic pathological characteristics of cardiac ruptures of different causes for their differential diagnosis. METHODS We analyzed the data of 44 autopsy cases of cardiac rupture from 2014 to 2017 in our institute, including 11 cases caused by blunt violence with intact pericardium, 4 caused by cardiopulmonary resuscitation (CPR), 9 by myocardial infarction, and 20 by aorta dissection rupture.The gross features and histopathological characteristics of cardiac rupture and pericardial effusion were analyzed and compared. RESULTS Cardiac ruptures caused by blunt violence varied in both morphology and locations, and multiple ruptures could be found, often accompanied with rib or sternum fractures; the volume of pericardial effusion was variable in a wide range; microscopically, hemorrhage and contraction band necrosis could be observed in the cardiac tissue surrounding the rupture.Cardiac ruptures caused by CPR occurred typically near the apex of the right ventricular anterior wall, and the laceration was often parallel to the interventricular septum with frequent rib and sternum fractures; the volume of pericardial blood was small without blood clots; microscopic examination only revealed a few hemorrhages around the ruptured cardiac muscular fibers.Cardiac ruptures due to myocardial infarction caused massive pericardial blood with blood clots, and the blood volume was significantly greater than that found in cases of CPR-induced cardiac rupture (P < 0.05);lacerations were confined in the left ventricular anterior wall, and the microscopic findings included myocardial necrosis, inflammatory cell infiltration, and mural thrombus.Cardiac tamponade resulting from aorta dissection rupture was featured by massive pericardial blood with blood clots, and the blood volume was much greater than that in cases of cardiac ruptures caused by blunt violence, myocardial infarction and CPR (P < 0.05). CONCLUSIONS Hemorrhage, inflammatory cell infiltration, and lateral thrombi around the cardiac rupture, along with pericardial blood clots, are all evidences of antemortem injuries.
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Affiliation(s)
- Dianshen Wang
- Nansha Branch of Guangzhou Public Security Bureau, Guangzhou 511457, China
| | - Fu Zhang
- Key Lab of Forensic Medicine of Guangdong Public Security Department, Guangzhou 510050, China
| | - Yunle Meng
- College of Forensic Medicine, Southern Medical University, Guangzhou 510515, China.,Guangdong Traffic Accident Appraisal Engineering Technology Research Center, Guangzhou 510515, China
| | - Yangeng Yu
- Key Lab of Forensic Medicine of Guangdong Public Security Department, Guangzhou 510050, China
| | - Kai Zhou
- Nansha Branch of Guangzhou Public Security Bureau, Guangzhou 511457, China
| | - Leping Sun
- College of Forensic Medicine, Southern Medical University, Guangzhou 510515, China.,Guangdong Traffic Accident Appraisal Engineering Technology Research Center, Guangzhou 510515, China
| | - Qi Miao
- College of Forensic Medicine, Southern Medical University, Guangzhou 510515, China.,Guangdong Traffic Accident Appraisal Engineering Technology Research Center, Guangzhou 510515, China
| | - Dongri Li
- College of Forensic Medicine, Southern Medical University, Guangzhou 510515, China.,Guangdong Traffic Accident Appraisal Engineering Technology Research Center, Guangzhou 510515, China
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16
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Rupprecht H, Gaab K. Delayed Cardiac Rupture Induced by Traumatic Myocardial Infarction: Consequence of a 45-Magnum Blast Injury; A Comprehensive Case Review. Bull Emerg Trauma 2018; 6:1-7. [PMID: 29379803 DOI: 10.29252/beat-060101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A penetrating chest trauma, a myocardial contusion or a myocardial infarction can lead to a cardiac rupture, which is linked to an extreme high death rate. Only few cases with delayed perforation of the myocardium have been reported in literature. We report about a penetrating gunshot injury, which led to a myocardial contusion with secondary delayed rupture of the left ventricle and the left inferior lobe of the lung. The leakage of the lesion in the left ventricle could be sealed sufficiently with fibrin-coated collagen fleeces after adapting stitches with Prolene 2-0. For additional stabilization of the vulnerable myocardium area, a bovine patch has been placed on the damaged ventricle. Fibrin fleeces are used successfully in cardiac surgery, as in our case, to seal the leakage of the lesion in the left ventricle. The implantation of a bovine patch in the pericardium could prevent a cardiac compartment syndrome with a fatal pericardial tamponade. To prohibit a thoracic compartment syndrome a modified Bogota bag could be sewed in for temporarily closure of the chest. In most cases penetrating cardiac injuries can be treated without heart-lung-machines. An immediate transfer to a cardio-surgical center is, due to the acute situation, not possible. If a surgeon with thoraco-surgical expertise is present a transfer is not absolutely necessary.
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Affiliation(s)
- Holger Rupprecht
- Department of General and Visceral Surgery and Thoracic, Clinical Center Fuerth, Fuerth, Bavaria, Germany 90766
| | - Katharina Gaab
- Department of General and Visceral Surgery and Thoracic, Clinical Center Fuerth, Fuerth, Bavaria, Germany 90766
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Ishida K, Kinoshita Y, Iwasa N, Nakae M, Sakaki M, Ieki Y, Takahashi K, Shimahara Y, Sogabe T, Shimono K, Noborio M, Sadamitsu D. Emergency room thoracotomy for acute traumatic cardiac tamponade caused by a blunt cardiac injury: A case report. Int J Surg Case Rep 2017; 35:21-24. [PMID: 28427001 PMCID: PMC5397131 DOI: 10.1016/j.ijscr.2017.03.009] [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: 12/12/2016] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Traumatic blunt cardiac injuries have a high mortality rate, and prompt diagnosis and treatment can be lifesaving in cardiac tamponade. PRESENTATION OF CASE A 62-year-old man was transferred to the emergency department after a motor vehicle accident. He was hemodynamically unstable. A focused assessment with sonography in trauma (FAST) showed pericardial fluid with right ventricular collapse consistent with cardiac tamponade in the subxiphoid view. He collapsed despite a subxiphoid pericardiotomy. Owing to the ongoing hemodynamic instability, we performed a left anterolateral thoracotomy. Direct incision of the pericardium showed blood and clots within the pericardial space, indicating hemopericardium. The heart stroke and hemodynamic status recovered on removing the clot. DISCUSSION Although the physical findings of cardiac tamponade are not always apparent in life-threatening acute cardiac tamponade after blunt trauma, FAST is a reliable tool for diagnosing and following cardiac tamponade. A median sternotomy is a standard approach for evaluating cardiac injury in hemodynamically stable patients with or without cardiopulmonary bypass. However, a left anterior thoracotomy was the fastest, simplest life-saving procedure considering the need for open-chest cardiac massage given our patient's life-threatening condition. CONCLUSION A prompt diagnosis using FAST and treatment can be lifesaving in traumatic acute cardiac tamponade. A pericardiotomy via a thoracotomy is mandatory for lifesaving cardiac decompression in acute traumatic cardiac tamponade in cases of ineffective drainage due to clot formation within the pericardial space.
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Affiliation(s)
- Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan.
| | - Yoshihiro Kinoshita
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Nobutaka Iwasa
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Masaro Nakae
- Department of Cardiovascular Surgery, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Masayuki Sakaki
- Department of Cardiovascular Surgery, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Yohei Ieki
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Kyosuke Takahashi
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Yumiko Shimahara
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Taku Sogabe
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Keiichiro Shimono
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Mitsuhiro Noborio
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Daikai Sadamitsu
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
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Baxi AJ, Restrepo C, Mumbower A, McCarthy M, Rashmi K. Cardiac Injuries: A Review of Multidetector Computed Tomography Findings. Trauma Mon 2015; 20:e19086. [PMID: 26839855 PMCID: PMC4727463 DOI: 10.5812/traumamon.19086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 06/12/2014] [Accepted: 07/12/2014] [Indexed: 01/15/2023] Open
Abstract
Trauma is the leading cause of death in United States in the younger population. Cardiac trauma is common following blunt chest injuries and is associated with high morbidity and mortality. This study discusses various multidetector computed tomography (MDCT) findings of cardiac trauma. Cardiac injuries are broadly categorized into the most commonly occurring blunt cardiac injury and the less commonly occurring penetrating injury. Signs and symptoms of cardiac injury can be masked by the associated injuries. Each imaging modality including chest radiographs, echocardiography, magnetic resonance imaging and MDCT has role in evaluating these patients. However, MDCT is noninvasive; universally available and has a high spatial, contrast, and temporal resolution. It is a one stop shop to diagnose and evaluate complications of cardiac injury. MDCT is an imaging modality of choice to evaluate patients with cardiac injuries especially the injuries capable of causing hemodynamic instability.
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Affiliation(s)
- Ameya Jagdish Baxi
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
- Corresponding author: Ameya Jagdish Baxi, Department of Radiology, University of Texas Health Science Center, San Antonio, USA. Tel: +1-2105675535, E-mail:
| | - Carlos Restrepo
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Amy Mumbower
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Michael McCarthy
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Katre Rashmi
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
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Adams A, Fotiadis N, Chin JY, Sapsford W, Brohi K. A pictorial review of traumatic pericardial injuries. Insights Imaging 2012; 3:307-11. [PMID: 22695953 PMCID: PMC3481075 DOI: 10.1007/s13244-012-0177-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/13/2012] [Accepted: 04/16/2012] [Indexed: 11/25/2022] Open
Abstract
Background Thoracic injuries are the third most common injuries in trauma patients with cardiac injuries amongst the most lethal. Imaging is essential in diagnosis and triage of patients with pericardial injuries, and this review aims to highlight the spectrum of imaging findings of pericardial trauma. Focussed assessment with sonography for trauma (FAST) is the preferred initial examination, being rapid and accurate. Sensitivity of FAST for pericardial fluid detection is high with reported sensitivities of 97–100%. Plain chest radiography has low sensitivity for pericardial injuries but is useful in the evaluation of associated injuries. Computed tomography (CT) is the modality of choice for stable patients and can accurately diagnose traumatic pathology of the pericardium being especially useful in identification of cardiac herniation. The spectrum of CT findings includes pericardial fluid collections, focal pericardial defects and pneumopericardium. Methods A selection of cases of pericardial trauma encountered at a level one trauma centre is presented. Operative findings were correlated with the FAST scan, plain radiography and computed tomography imaging. Conclusion The imaging findings of pericardial trauma with various imaging modalities (ultrasound, plain radiography and computed tomography) are presented in order to aid interpretation during the acute trauma setting.
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Affiliation(s)
- Ashok Adams
- The Royal London Hospital, Barts and the London NHS Trust, Whitechapel Road, Whitechapel, London, E1 1BB, UK
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Restrepo CS, Gutierrez FR, Marmol-Velez JA, Ocazionez D, Martinez-Jimenez S. Imaging Patients with Cardiac Trauma. Radiographics 2012; 32:633-49. [DOI: 10.1148/rg.323115123] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Co SJ, Yong-Hing CJ, Galea-Soler S, Ruzsics B, Schoepf UJ, Ajlan A, Aljan A, Farand P, Nicolaou S. Role of imaging in penetrating and blunt traumatic injury to the heart. Radiographics 2012; 31:E101-15. [PMID: 21768229 DOI: 10.1148/rg.314095177] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac injury due to blunt or penetrating chest trauma is common and is associated with significant morbidity and mortality. Understanding the mechanisms, types, and complications of cardiac injuries and the roles of various imaging modalities in characterizing them is important for appropriate diagnosis and treatment. These injuries have not been well documented at imaging, but there are now fast and accurate methods for evaluating the heart and associated mediastinal structures. The authors review the broad spectrum of injuries that can result from blunt or penetrating trauma to the chest, as well as the imaging modalities commonly used in the acute trauma setting for evaluation of the heart and mediastinal structures. A pictorial review of both common and, to date, rarely documented cardiac injuries imaged with a variety of modalities is also presented. While many imaging modalities are available, the authors demonstrate the value of multidetector computed tomography (CT) for the initial evaluation of patients with blunt or penetrating chest trauma. With the advent of multidetector CT, imaging of cardiac injury has increased and accurate identification of these rare but potentially lethal injuries has become paramount for improving survival. Selection of the most appropriate modality for evaluation and recognition of the imaging findings in cardiac injuries in the acute trauma setting is important to expedite treatment and improve survival.
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Affiliation(s)
- Steven J Co
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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22
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Assing M, Dragicevic N, Hazelton TR, Nallamshetty L. Delayed levorotation of the heart in traumatic pericardial rupture. Emerg Radiol 2010; 18:257-61. [DOI: 10.1007/s10140-010-0923-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 11/22/2010] [Indexed: 11/25/2022]
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