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Introduction
Rupture of the pericardium complicating blunt thoracic trauma may lead to cardiac luxation if not early recognized and appropriately surgically treated. This condition is exceedingly rare and carries a high mortality rate.
Case presentation
A 37-year-old man presented with severe multiple injuries following a road traffic crash, inclu...
Contexts in source publication
Context 1
... chest radiograph revealed a leftward deviation of the cardiac silhouette (Fig. 1). The findings of the electrocardiogram were normal, except for a sinus tachycardia. Given the hemodynamic stability and the availability of an early CT scan, FAST was not performed. A total body CT scan revealed a moderate left anterior pneumothorax, a negligible right pneumothorax, fracture of the middle arch of the 5th, 6th, seventh ...
Context 2
... chest radiograph revealed a leftward deviation of the cardiac silhouette (Figure 1). The findings of the electrocardiogram were normal, except for a sinus tachycardia. ...
Citations
... 4 Injuries of the heart occur in 23%-28% of the cases, mainly consisting of chamber rupture or valvular injury. 1,[15][16][17] Autopsy studies in people with concurrent cardiac injury and pericardial tears have reported that over 50% of victims die on scene, while another 26% die after hospital admission. 3 out rapid surgical intervention, and time for achievement of diagnosis of the condition has been implicated as the most significant prognostic factor in people. ...
Objective
To describe the unique finding and treatment of a dog with cardiac herniation due to traumatic pericardial rupture.
Case Summary
A 6.5‐year‐old entire male Yorkshire Terrier was presented for further management after being hit by a car. Despite suspected significant intrathoracic trauma at that time, the patient regained hemodynamic stability and had orthopedic surgery to correct a right iliac fracture. The patient was readmitted to the hospital 12 days following the initial visit due to considerable respiratory difficulty after accidentally being dropped several feet. Thoracic radiographs revealed an unusual severe mediastinal shift to the left with an atypical position of the cardiac silhouette against the left lateral thoracic wall. Due to the severe respiratory compromise of the patient and newly developed pneumothorax, an exploratory thoracotomy was recommended, where a complete rupture of the pericardium was identified, with secondary left‐sided prolapse of the heart. Other more common intrathoracic injuries (ie, lung perforation, rib fractures) were also identified and partially repaired. The patient recovered successfully and was discharged 4 days postoperatively.
New or Unique Information Provided
This is the first case report in the veterinary literature of traumatic pericardial rupture and cardiac herniation. According to human case descriptions, this is a rare and often fatal occurrence, which can be significantly challenging to diagnose preoperatively or antemortem. Emergency veterinary clinicians should be aware of this rare but important complication of blunt thoracic trauma. Surgical intervention may be necessary in cases with suspected or confirmed entrapment of great vessels or cardiac chambers, although these abnormalities were not present in this case.
... Post-traumatic blunt pericardial injury is rare but has occasionally been reported [1][2][3][4]. Once diagnosed, surgical repair is mandatory as this condition can trigger devastating complications [5,6]. However, in some cases, cardiac herniations may be misdiagnosed or masked by concomitant injury. ...
... Pneumo-or hemopericardium strongly suggests heart damage; therefore, these are considered strong indicators that intensive treatment, such as surgery, will be required. However, in the classification of traumatic cardiac dislocations proposed by Graef et al [3], grade I pericardial rupture without dislocation of the heart can barely be detected on CT scans, and entirely secondary findings in patients with a diaphragm with intrathoracic herniation of abdominal organs can be diagnosed by chest radiography or CT [7]. Similarly, in our case, no preoperative examination suggested pericardial rupture. ...
Background:
Post-traumatic blunt pericardial injury is a rare condition with only a few reported cases which were generally diagnosed during initial examinations upon admission. However, pericardial injuries not bad enough to dislocate the heart may only cause intermittent electrocardiogram (ECG) changes or be asymptomatic.
Case summary:
In this case, we report a blunt pericardial injury undetected on preoperative transthoracic echocardiography and chest computed tomography. We misjudged intermittent ECG changes and blood pressure fluctuations as minor symptoms resulting from cardiac contusion and did not provide intensive treatment. The pericardial injury was found incidentally during surgical stabilization of rib fractures and was successfully repaired.
Conclusion:
Post-traumatic blunt pericardial ruptures should be considered in patients with blunt chest trauma showing abnormal vital signs and ECG changes.
