ACR Appropriateness Criteria® Blunt Chest Trauma-Suspected Cardiac Injury

Stojanovska, Jadranka; Koweek, Lynne M. Hurwitz; Chung, Jonathan H.; Ghoshhajra, Brian; Walker, Christopher M.; Beache, Garth M.; Berry, Mark F.; Colletti, Patrick M.; Davis, Andrew M.; Hsu, Joe Y.; Khosa, Faisal; Kicska, Gregory; Kligerman, Seth; Litmanovich, Diana; Maroules, Christopher D.; Meyersohn, Nandini M.; Syed, Mushabbar A.; Tong, Betty C.; Villines, Todd C.; Wann, Samuel; Wolf, Stephen J.; Kanne, Jeffrey P.; Abbara, Suhny

doi:10.1016/j.jacr.2020.09.012

Cited by 12 publications

(11 citation statements)

References 68 publications

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“… 6 The American College of Radiology Appropriateness Criteria for Blunt Chest Trauma–Suspected Cardiac Injury list chest CT or CT angiography with or with and without intravenous contrast as an appropriate study for the stable patient with suspicion of injury. 7 There is little guidance for use of cardiac magnetic resonance imaging in this setting; however, given its high-resolution imaging and increased utility for diagnosis of myocardial injury, in our opinion it is an appropriate cardiac imaging test in those with suspected BCI. 8…”

Section: Discussionmentioning

confidence: 99%

Cardiac Contusion Complicated by Heart Failure in a Young Athlete

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Cardiac Contusion Complicated by Heart Failure in a Young Athlete

et al. 2022

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“…The presence of a small enhanced pericardial effusion on computed tomography is useful for the diagnosis of cardiac perforation caused by blunt cardiac injury. It has been reported that, although enhanced computed tomography imaging is not possible in all cases of blunt cardiac injury, cardiac perforation caused by blunt cardiac injury could be diagnosed in cases with leakage from the cardiac wall or enhanced pericardial effusion [9] , [10] . Similarly, cardiac perforation with pericardial injury that does not show sufficient pericardial effusion for detection by echocardiography could be diagnosed based on enhancement of a small pericardial effusion.…”

Section: Discussionmentioning

confidence: 99%

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

Esumi

Kaneko

Akama

et al. 2021

Trauma Case Reports

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Blunt trauma may cause cardiac perforation requiring emergency surgical repair. Cardiac perforations are usually diagnosed by the presence of a pericardial effusion on echocardiography. However, cardiac perforations and pericardial effusions are sometimes too small to detect, resulting in underdiagnosis. In this case report, we describe a 22-year-old man who was involved in a traffic accident, admitted in a state of shock, and was initially treated for tension pneumothorax and liver and spleen injuries. His initial computed tomography scans revealed a small region of enhancement, corresponding to a small pericardial effusion, indicative of a cardiac perforation. Thus, an emergency median sternotomy was performed. He was diagnosed with perforation of the left atrial ear and right atrium, which were repaired surgically. His liver and spleen injuries were also treated, and the patient was discharged 44 days after admission. The detection of a small pericardial effusion on enhanced computed tomography enabled rapid diagnosis of a cardiac perforation and ensured emergency surgical repair could be performed as soon as possible. Learning objectives To acknowledge the difficulty of diagnosing cardiac perforation in patients with pericardial injury, based on conventional signs of blunt cardiac injury, such as sternal fracture, serum cardiac enzymes, and hemothorax. To recognize that a small pericardial effusion on enhanced computed tomography scans is an important finding that should raise suspicion of cardiac perforation and pericardial injury.

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“…5 TTE is the most common and widely accepted noninvasive test for BCI diagnosis. 11 TEE generally is reserved for patients in whom TTE is suboptimal or in whom the TTE findings require further characterization. Although TEE provides more accurate information, it is invasive and may not be available in all clinical settings.…”

Section: Key Pointsmentioning

confidence: 99%

“…Although TEE provides more accurate information, it is invasive and may not be available in all clinical settings. 11 Often, patients presenting with a traumatic mechanism will initially undergo CT imaging, which has been accepted as the test of choice for blunt chest trauma in hemodynamically stable patients. 11,12 This test can be obtained rapidly and can diagnose other injuries concurrently but does not evaluate the dynamic function of the heart.…”

Section: Key Pointsmentioning

confidence: 99%

Blunt cardiac injury in the hemodynamically stable patient

Calzone,

Grossman

2024

Jaapa

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Blunt cardiac injury (BCI) describes a spectrum of problems including severe, potentially life-threatening injuries from trauma. Pericardial effusion is an example of a BCI that has generally been assumed to imply serious underlying injury to the heart and should be considered hemopericardium until proven otherwise. A standard of care has been established to screen for BCI and treat hemodynamically unstable patients with an acute pericardial effusion presumably related to BCI. Less agreement exists on definitive treatment for hemodynamically stable patients with pericardial effusion after blunt cardiac trauma. This case study explores a new treatment for small to moderate hemopericardium in a stable patient after BCI.

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ACR Appropriateness Criteria® Blunt Chest Trauma-Suspected Cardiac Injury

Cited by 12 publications

References 68 publications

Cardiac Contusion Complicated by Heart Failure in a Young Athlete

Cardiac Contusion Complicated by Heart Failure in a Young Athlete

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

Blunt cardiac injury in the hemodynamically stable patient

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