A case report: hemothorax caused by rupture of the left atrial appendage

Oizumi, Hiroaki; Suzuki, Kenji; Hoshino, Hironobu; Tatsumori, Takahiro; Ichinokawa, Hideomi

doi:10.1186/s40792-016-0270-2

Cited by 13 publications

(16 citation statements)

References 12 publications

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“…Also, the junction of atria and great veins is a common site for blunt cardiac ruptures [ 2 , 7 ]. In blunt cardiac rupture, associated pericardial tear is found in up to 30% of cases due to increased intra-abdominal pressure or rapid deceleration [ 9 ]. It is not uncommon to diagnose pericardial rupture during thoracotomy without pre-emption [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

A successful off-pump cardiac repair following blunt cardiac rupture – A case report

Katiyar

Kumar

et al. 2020

Trauma Case Reports

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A 25-year-old male truck driver presented to Emergency Department following unrestrained heavy motor vehicle crash (MVC), when the high-speed truck collided to a wall. He sustained blunt chest trauma from steering wheel and open fracture of right tibia with compartment syndrome. On primary survey, patient was in shock with patent airway. Focused assessment sonography for trauma (FAST) suggested cardiac tamponade for which ultrasound-guided pericardial catheter was placed. After resuscitation patient was taken to the operation theatre. Clam-shell thoracotomy revealed rents in left atrial appendages which were repaired. Fasciotomy of leg was performed and external fixator was applied for open tibia fracture. The patient developed surgical site infection that was treated with local antibiotic and regular dressings. After two weeks, fasciotomy wound was closed with split-skin grafting. At nine-month follow-up, patient was able to resume his occupation as a heavy motor vehicle driver.

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Section: Discussionmentioning

confidence: 99%

A successful off-pump cardiac repair following blunt cardiac rupture – A case report

Katiyar

Kumar

et al. 2020

Trauma Case Reports

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“…Pericardial tears often occur secondary to increased intra-abdominal pressure or lateral decelerative forces from either side. In blunt injury with cardiac rupture, 70% of the time the pericardium stays intact; in 30% of cases it ruptures [ 12 ]. Cardiac herniation with cardiac dysfunction can occur in conjunction with these tears.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac rupture is a rare etiology of hemothorax. In a recent series of cases, Oizumi et al [ 12 ] describes only 11 known patients who have survived blunt cardiac rupture with a concomitant pericardial defect [ 12 ]. Our patient would perhaps be the 12th.…”

Section: Discussionmentioning

confidence: 99%

Case reports of atrial and pericardial rupture from blunt cardiac trauma

Baldwin

Chow

Mashbari

et al. 2018

J Cardiothorac Surg

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BackgroundBlunt cardiac trauma is diagnosed in less than 10% of trauma patients and covers the range of severity from clinically insignificant myocardial contusions to lethal multi-chamber cardiac rupture. The most common mechanisms of injury include: motor vehicle collisions (MVC), pedestrians struck by motor vehicles and falls from significant heights. A severe complication from blunt cardiac trauma is cardiac chamber rupture with pericardial tear. It is an exceedingly rare diagnosis. A retrospective review identified only 0.002% of all trauma patients presented with this condition. Most patients with atrial rupture do not survive transport to the hospital and upon arrival diagnosis remains difficult.Case presentationWe present two cases of atrial and pericardial rupture. The first case is a 33-year-old female involved in a MVC, who presented unresponsive, hypotensive and tachycardic. A left sided hemothorax was diagnosed and a chest tube placed with 1200 mL of bloody output. The patient was taken to the OR emergently. Intraoperatively, a laceration in the right pericardium and a 3 cm defect in the anterior, right atrium were identified. Despite measures to control hemorrhage and resuscitate the patient, the patient did not survive.The second case is a 58-year-old male involved in a high-speed MVC. Similar to the first case, the patient presented unresponsive, hypotensive and tachycardic with a left sided hemothorax. A chest tube was placed with 900 mL of bloody output. Based on the output and ongoing resuscitation requirements, the patient was taken to the OR. Intraoperatively, a 15 cm anterior pericardial laceration was identified. Through the defect, there was brisk bleeding from a 1 cm laceration on the left atrial appendage. The injury was debrided and repaired using a running 3–0 polypropylene suture over a Satinsky clamp. The patient eventually recovered and was discharged home.ConclusionsWe present two cases of uncontained atrial and pericardial rupture from blunt cardiac trauma. Contained ruptures with an intact pericardium present as a cardiac tamponade while uncontained ruptures present with hemomediastinum or hemothorax. A high degree of suspicion is required to rapidly diagnose and perform the cardiorrhaphy to offer the best chance at survival.

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“…These findings indicate that the cardiac arrest occurred from cardiac tamponade induced by the AAD, after which vigorous chest compressions likely caused the pericardial laceration that drained the cardiac tamponade into the left pleural space, resulting in the hemothorax. In fact, hemothorax, not cardiac tamponade, has often been reported in patients with traumatic cardiac rupture who also have pericardial laceration [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Pericardial injury from chest compression: a case report of incidental release of cardiac tamponade

et al. 2018

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BackgroundAlthough chest compression is a standard technique in cardiopulmonary resuscitation, it is well recognized that manual chest compression causes various internal injuries, of which major injuries are often fatal. Similarly, when cardiac tamponade occurs in patients with type A acute aortic dissection, many patients die before reaching the hospital. We report a rare case in which chest compressions caused pericardial laceration that may have inadvertently played a life-saving role in releasing cardiac tamponade induced by acute aortic dissection.Case presentationA 67-year-old woman developed cardiac arrest soon after complaining of epigastric pain, and after successful resuscitation by manual chest compression, she was transferred to our hospital. On arrival, the patient was 14 on the Glasgow Coma Scale. An ECG showed a normal sinus rhythm, and no arrhythmias or signs of myocardial ischemia were observed. A chest X-ray revealed left pleural effusion, while cardiomegaly and pneumothorax were not identified. Computed tomography revealed type A aortic dissection, mild pericardial effusion, and massive left pleural effusion. No pulmonary embolus was found on the CT. After drainage of bloody effusion from the left pleural space, an emergency operation was begun. During surgery, a pericardial laceration with communication to the left pleural space and a hemothorax were found; however, no cardiac injury was identified. No other intra-thoracic injuries or rupture of the aortic dissection causing the hemothorax were detected. Hemiarch replacement was performed without difficulty, but the patient died of multi-organ failure 30 days after surgery.ConclusionsWe report a case of pericardial injury without skeletal fracture caused by chest compression. The pericardial laceration may have inadvertently served to release the cardiac tamponade induced by the acute aortic dissection, resulting in the hemothorax, and provided time to receive surgery.

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A case report: hemothorax caused by rupture of the left atrial appendage

Cited by 13 publications

References 12 publications

A successful off-pump cardiac repair following blunt cardiac rupture – A case report

A successful off-pump cardiac repair following blunt cardiac rupture – A case report

Case reports of atrial and pericardial rupture from blunt cardiac trauma

Pericardial injury from chest compression: a case report of incidental release of cardiac tamponade

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