1
|
Becker ER, Price AD, Whitrock JN, Smith M, Baucom MR, Makley AT, Goodman MD. Re-evaluating the Use of High Sensitivity Troponin to Diagnose Blunt Cardiac Injury. J Surg Res 2024; 300:150-156. [PMID: 38815513 DOI: 10.1016/j.jss.2024.04.074] [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: 12/04/2023] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Blunt cardiac injury (BCI) can be challenging diagnostically, and if misdiagnosed, can lead to life-threatening complications. Our institution previously evaluated BCI screening with troponin and electrocardiogram (EKG) during a transition from troponin I to high sensitivity troponin (hsTnI), a more sensitive troponin I assay. The previous study found an hsTnI of 76 ng/L had the highest capability of accurately diagnosing a clinically significant BCI. The aim of this study was to determine the efficacy of the newly implemented protocol. METHODS Patients diagnosed with a sternal fracture from March 2022 to April 2023 at our urban level-1 trauma center were retrospectively reviewed for EKG findings, hsTnI trend, echocardiogram changes, and clinical outcomes. The BCI cohort and non-BCI cohort ordinal measures were compared using Wilcoxon's two-tailed rank sum test and categorical measures were compared with Fisher's exact test. Youden indices were used to evaluate hsTnI sensitivity and specificity. RESULTS Sternal fractures were identified in 206 patients, of which 183 underwent BCI screening. Of those screened, 103 underwent echocardiogram, 28 were diagnosed with clinically significant BCIs, and 15 received intervention. The peak hsTnI threshold of 76 ng/L was found to have a Youden index of 0.31. Rather, the Youden index was highest at 0.50 at 40 ng/L (sensitivity 0.79 and specificity 0.71) for clinically significant BCI. CONCLUSIONS Screening patients with sternal fractures for BCI using hsTnI and EKG remains effective. To optimize the hsTnI threshold, this study determined the hsTnI threshold should be lowered to 40 ng/L. Further improvements to the institutional protocol may be derived from multicenter analysis.
Collapse
Affiliation(s)
- Ellen R Becker
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Adam D Price
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Jenna N Whitrock
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Maia Smith
- Cape Fox Federal Integrators, Manassas, Virginia
| | - Matthew R Baucom
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Amy T Makley
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | | |
Collapse
|
2
|
Mehta H, Gheith Z, Amin S, Acharya P, Daon E, Downey P, Hockstad E, Wiley M, Muehlebach G, Zorn G, Danter M, Gupta K. Trends of Hospitalizations and In-Hospital Outcomes for Traumatic Cardiac Injury in United States. Kans J Med 2024; 17:45-50. [PMID: 38859990 PMCID: PMC11164420 DOI: 10.17161/kjm.vol17.21442] [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: 11/09/2023] [Accepted: 04/14/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Traumatic cardiac injury (TCI) poses a significant risk of morbidity and mortality, yet there is a lack of population-based outcomes data for these patients. Methods The authors examined national yearly trends, demographics, and in-hospital outcomes of TCI using the National Inpatient Sample from 2007 to 2014. We focused on adult patients with a primary discharge diagnosis of TCI, categorizing them into blunt (BTCI) and penetrating (PTCI) cardiac injury. Results A total of 11,510 cases of TCI were identified, with 7,155 (62.2%) classified as BTCI and 4,355 (37.8%) as PTCI. BTCI was predominantly caused by motor vehicle collisions (66.7%), while PTCI was mostly caused by piercing injuries (67.4%). The overall mortality rate was 11.3%, significantly higher in PTCI compared to BTCI (20.3% vs. 5.9%, χ2(1, N = 11,185) = 94.9, p <0.001). Additionally, 21.5% required blood transfusion, 19.6% developed hemopericardium, and 15.9% suffered from respiratory failure. Procedures such as heart and pericardial repair were more common in PTCI patients. Length of hospitalization and cost of care were also significantly higher for PTCI patients, W(1, N = 11,015) = 88.9, p <0.001). Conclusions Patients with PTCI experienced higher mortality rates than those with BTCI. Within the PTCI group, young men from minority racial groups and low-income households had poorer outcomes. This highlights the need for early and specialized attention from emergency and cardiothoracic providers for patients in these demographic groups.
Collapse
Affiliation(s)
- Harsh Mehta
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
| | - Zaid Gheith
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Internal Medicine
| | - Saad Amin
- University of Texas Medical Branch, Galveston, TX
- Department of Internal Medicine
| | - Prakash Acharya
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
| | - Emmanuel Daon
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - Peter Downey
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - Eric Hockstad
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
| | - Mark Wiley
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
| | - Gregory Muehlebach
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - George Zorn
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - Matthew Danter
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiothoracic Surgery
| | - Kamal Gupta
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Cardiovascular Medicine
| |
Collapse
|
3
|
Chastain C, Dockery A, Gordon E, Olsen A, Simon J, Summerow M, Do MM. Electrophysiologic changes related to blunt cardiac injury: Clinical practice pearls. HeartRhythm Case Rep 2024; 10:169-170. [PMID: 38404982 PMCID: PMC10885717 DOI: 10.1016/j.hrcr.2024.01.005] [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: 02/27/2024] Open
Affiliation(s)
| | | | | | | | | | | | - Monika Marie Do
- US Department of Veterans Affairs & Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
4
|
Hickcox L, Hashemzadeh M, Movahed MR. Very low risk of ST-elevation and non-ST-elevation myocardial infarction in patients with chest trauma. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:247-251. [PMID: 37736353 PMCID: PMC10509452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The goal of this study was to evaluate any association between blunt chest trauma and occurrence of ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. METHODS Data from the National Inpatient Sample (NIS) database from 2010-2014, of patients over the age of 40, hospitalized for blunt chest trauma (ICD 959.11), with STEMI or NSTEMI, was used in this study. We performed a chi-squared test to analyze this association. We also performed a multivariant analysis adjusting for race, gender, and age. RESULTS We found that there is not an increased risk of STEMI/NSTEMI following blunt chest trauma, P > 0.05. We also found no correlation between STEMI or NSTEMI and chest trauma after adjusting for race, gender, and age. For STEMI after adjustments in 2010 (P=0.52), 2011 (P=0.19), 2012 (P=0.60), 2013 (P=0.88), and 2014 (P=0.14). For NSTEMI adjustments in 2010 (P=0.03), 2011 (P=0.06), 2012 (P=0.01), 2013 (P=0.21), and 2014 (P=0.03). CONCLUSION Both ST-elevation myocardial infarction and non-ST-elevation myocardial infarction were not significantly associated with blunt chest trauma.
Collapse
Affiliation(s)
- Lucy Hickcox
- Mercy Regional Medical CenterDurango, Colorado, USA
- Fort Lewis CollegeDurango, Colorado, USA
| | | | - Mohammad Reza Movahed
- University of ArizonaPhoenix, Arizona, USA
- University of Arizona Sarver Heart CenterTucson, Arizona, USA
| |
Collapse
|
5
|
Pollock GA, Lo J, Chou H, Kissen MS, Kim M, Zhang V, Betz A, Perlman R. Advanced diagnostic and therapeutic techniques for anaesthetists in thoracic trauma: an evidence-based review. Br J Anaesth 2023; 130:e80-e91. [PMID: 36096943 DOI: 10.1016/j.bja.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/27/2022] [Accepted: 07/02/2022] [Indexed: 01/06/2023] Open
Abstract
Anaesthetists play an important role in the evaluation and treatment of patients with signs of thoracic trauma. Anaesthesia involvement can provide valuable input using both advanced diagnostic and therapeutic interventions. Commonly performed interventions may be complicated in this setting including airway management, damage control resuscitation, and acute pain management. Anaesthetists must consider additional factors including airway injuries, vascular injuries, and coagulopathy when treating this population. This evidence-based review discusses traumatic thoracic injuries with a focus on new interventions and modern anaesthesia techniques. This review further serves to support the early involvement of anaesthetists in the emergency department and other areas where they can provide value to the trauma care pathway.
Collapse
Affiliation(s)
- Gabriel A Pollock
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Regional Anaesthesia & Acute Pain Service Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jessie Lo
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Regional Anaesthesia & Acute Pain Service Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Henry Chou
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael S Kissen
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Regional Anaesthesia & Acute Pain Service Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michelle Kim
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Vida Zhang
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Thoracic Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Trauma Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander Betz
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ryan Perlman
- Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Trauma Anaesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
6
|
Okeke RI, Saliba C, Cao J, Lee F, Parrish BP, Nadella J, Miyata S, Blewett C. Traumatic Left Anterior Descending Artery Dissection in a Case of Pediatric Blunt Chest Trauma. Cureus 2022; 14:e31477. [DOI: 10.7759/cureus.31477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
|
7
|
Blunt thoracic trauma: role of chest radiography and comparison with CT - findings and literature review. Emerg Radiol 2022; 29:743-755. [PMID: 35595942 DOI: 10.1007/s10140-022-02061-1] [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: 03/18/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
In the setting of acute trauma where identification of critical injuries is time-sensitive, a portable chest radiograph is broadly accepted as an initial diagnostic test for identifying benign and life-threatening pathologies and guiding further imaging and interventions. This article describes chest radiographic findings associated with various injuries resulting from blunt chest trauma and compares the efficacy of the chest radiograph in these settings with computed tomography (CT). Common chest radiographic findings in blunt thoracic injuries will be reviewed to improve radiologic identification, expedite management, and improve trauma morbidity and mortality. This article discusses demographic information, mechanism of specific injuries, common imaging findings, imaging pearls, and pitfalls and exhibits several classic imaging findings in blunt chest trauma. Thoracic structures commonly injured in blunt trauma that will be discussed in this article include vasculature structures (aortic trauma), the heart (cardiac contusion, pericardial effusion), the esophagus (esophageal perforation), pleural space and airways (pneumothorax, hemothorax, bronchial injury), lungs (pulmonary contusion), the diaphragm (diaphragmatic rupture), and the chest wall (flail chest). Chest radiography plays an important role in the initial evaluation of blunt chest trauma. While CT imaging has a higher sensitivity than chest radiography, it remains a valuable tool due to its ability to provide rapid diagnostic information in time-sensitive trauma situations and is ubiquitously available in the trauma bay. Familiarity with the gamut of injuries that may occur as well as identification of the associated chest radiograph findings can aid in timely diagnoses and prompt management in the setting of acute blunt chest trauma.
Collapse
|
8
|
Omoto K, Tanaka C, Fukuda R, Tagami T, Unemoto K. Comparison of the effectiveness of pericardiocentesis and surgical pericardiotomy in the prognosis of patients with blunt traumatic cardiac tamponade: a multicenter study using the Japan Trauma Data Bank. Acute Med Surg 2022; 9:e768. [PMID: 35769387 PMCID: PMC9209333 DOI: 10.1002/ams2.768] [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: 02/08/2022] [Accepted: 05/29/2022] [Indexed: 11/11/2022] Open
Abstract
Aim To compare the prognostic impact of pericardiocentesis (PCC) and surgical pericardiotomy (SP) in blunt traumatic pericardial tamponade. Methods Among 361,706 trauma patients registered in the Japan Trauma Data Bank from January 2004 to December 2018, we included those with blunt traumatic cardiac tamponade who underwent PCC and/or SP. We excluded patients with penetrating trauma, age younger than 15 years, Injury Severity Score (ISS) equal to 75, blood pressure 0 mmHg at the time of admission, head Abbreviated Injury Scale (AIS) score 5 or more, and those with missing data for outcomes. To examine the effect of SP, patients were divided into a PCC group and an SP‐only group. Missing values of age, sex, systolic blood pressure, respiratory rate, pulse rate, time from emergency call to hospital arrival, head AIS, chest AIS, abdomen/pelvis AIS, Glasgow Coma Scale score, and ISS were estimated using multiple imputation. In‐hospital mortality was analyzed using multivariable analysis, and we undertook a survival analysis. Results We analyzed 305 patients, 150 (49.2%) in the PCC group and 155 (50.8%) in the SP‐only group. The in‐hospital mortality rate was 40.7% in the PCC group and 76.8% in the SP‐only group. Multivariable analysis after multiple imputation showed an odds ratio of SP for in‐hospital mortality 5.34 (95% confidence interval, 2.80–10.18; P < 0.01) compared with PCC. Using the Kaplan–Meier method, SP showed a significant risk of mortality (hazard ratio 2.16; 95% confidence interval, 1.58–2.95; P < 0.01). Conclusions In patients with blunt traumatic cardiac tamponade, SP was associated with poor prognosis.
Collapse
Affiliation(s)
- Kenichiro Omoto
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Chie Tanaka
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine Nippon Medical School Musashikosugi Hospital Kawasaki Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Zhu H, Zhang C, Zhao W, Xu X, Shi Y, Zhao G. A rare survival case of blunt left ventricular rupture caused by a low-energy pedestrian collision with a stationary forklift: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1028. [PMID: 34277828 PMCID: PMC8267266 DOI: 10.21037/atm-21-3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/06/2022]
Abstract
Blunt cardiac rupture (BCR) is a rare injury with a high mortality rate. It is usually caused by high-energy traumatic accidents, such as motor vehicle collisions. For the first time, we report a rare case of BCR caused by a pedestrian collision with a stationary motor vehicle, which is a low-energy traumatic accident. This is also the first surgical survival BCR case to be reported of a contralateral ventricular rupture at the direct stress site. A 45-year-old formerly healthy Chinese woman, with no family history of heart disease, was walking in a hurry when she accidentally hit a forklift that was parked on the side of the road. The patient gradually lost consciousness, and was admitted to Hwa Mei Hospital Emergency Center 1 hour later. An ultrasound revealed a pericardial effusion about 1 cm deep and a small amount of peritoneal –35 effusion. Emergency computed tomography (CT) scans revealed a small amount of fluid accumulation in the right thoracic cavity, fractures of the 5th and 6th ribs on the right side, and pericardial effusion. The patient’s blood pressure remained unstable after 1 hour of endotracheal intubation, B-ultrasound-guided pericardiocentesis, and antishock therapy; thus, open-heart surgery was deemed necessary. A large amount of blood accumulation was found in the intact pericardium. There was a small blood clot at the apex of the left ventricle near the interventricular septum. The removal of the clot revealed a tear about 1 cm in diameter. The patient’s BCR was successfully repaired in the surgery. By the end of the 18-month follow-up period, the patient was found to have recovered well without significant complications. The internal mechanism of the case report was deceleration. Prompt diagnosis and emergency thoracotomy when BCR is suspected are key to rescuing patients, regardless of whether the accident is high energy or low energy, or if there is evidence of a direct force acting on the precordium, or the presence of pericardial rupture.
Collapse
Affiliation(s)
- Huangkai Zhu
- Department of Cardiothoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), Ningbo, China.,Medical School of Ningbo University, Ningbo, China
| | - Chenxu Zhang
- Department of Cardiothoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), Ningbo, China.,Medical School of Ningbo University, Ningbo, China
| | - Weidi Zhao
- Department of Cardiothoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), Ningbo, China.,Medical School of Ningbo University, Ningbo, China
| | - Xiang Xu
- Department of Cardiothoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), Ningbo, China
| | - Yiting Shi
- Department of Cardiothoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), Ningbo, China
| | - Guofang Zhao
- Department of Cardiothoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No. 2 Hospital), Ningbo, China.,Medical School of Ningbo University, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| |
Collapse
|
11
|
Mohamed S, Osman A, Patel A, Mazhar K, Srinivasan L, Balacumaraswami L. Delayed cardiac tamponade following blunt chest trauma due to disruption of fourth costal cartilage with posterior dislocation. Trauma Case Rep 2020; 29:100340. [PMID: 32793793 PMCID: PMC7415922 DOI: 10.1016/j.tcr.2020.100340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 11/20/2022] Open
Abstract
Cardiac tamponade is a recognised sequelae of non-penetrating and penetrating chest trauma. Delayed cardiac tamponade has been described following blunt chest trauma. We present a 29 year-old gentleman who had initially presented to peripheral district general hospital following direct blunt chest wall trauma. His initial trauma CT demonstrated a small mediastinal haematoma and large left haemopneumothorax and disruption/dislocation of the costal cartilage. He initially underwent a thoracoscopic procedure uneventfully. He then had worsening chest radiograph appearances with enlarging cardiac contours. Transthoracic echocardiography confirmed cardiac tamponade. He underwent creation of a pericardial window and excision of the protruding fourth costal cartilage.
Collapse
Affiliation(s)
- S Mohamed
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, United Kingdom
| | - A Osman
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, United Kingdom
| | - A Patel
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, United Kingdom.,Institute of Immunology and Immunotherapy, University of Birmingham, Vincent Drive, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - K Mazhar
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, United Kingdom
| | - L Srinivasan
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, United Kingdom
| | - L Balacumaraswami
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke On Trent, United Kingdom
| |
Collapse
|