Blunt chest trauma: a clinical chameleon

Abstract

The incidence of blunt chest trauma (BCT) is greater than 15% of all trauma admissions to the emergency departments worldwide and is the second leading cause of death after head injury in motor vehicle accidents. The mortality due to BCT is inhomogeneously described ranging from 9% to 60%. BCT is commonly caused by a sudden high-speed deceleration trauma to the anterior chest, leading to a compression of the thorax. All thoracic structures might be injured as a result of the trauma. Complex cardiac arrhythmia, heart murmurs, hypotension, angina-like chest pain, respiratory insufficiency or distention of the jugular veins may indicate potential cardiac injury. However, on admission to emergency departments symptoms might be missing or may not be clearly associated with the injury. Accurate diagnostics and early management in order to prevent serious complications and death are essential for patients suffering a BCT. Optimal initial diagnostics includes echocardiography or CT, Holter-monitor recordings, serial 12-lead electrocardiography and measurements of cardiac enzymes. Immediate diagnostics leading to the appropriate therapy is essential for saving a patient's life. The key aspect of the entire management, including diagnostics and treatment of patients with BCT, remains an interdisciplinary team involving cardiologists, cardiothoracic surgeons, imaging radiologists and trauma specialists working in tandem.

Severe Aortic and Tricuspid Valve Regurgitation after Blunt Chest Trauma: An Unusual Presentation

“…3 Blunt chest trauma is a common condition following motor vehicle collisions and is the second leading cause of death after brain injury. 1 Principal mechanisms related to BCT include rapid deceleration, torsion forces, high-energy injuries to the thorax, direct precordial impact, and abrupt pressure fluctuations in the chest and abdomen. 2,4 The leading cardiovascular damages after BCT are thoracic aortic injury and heart-specific (blunt cardiac) injuries.…”

“…8 Heart-specific injuries include myocardial contusion, cardiac rupture, valve injuries, papillary muscle dysfunction, pericardial complications, and coronary artery involvement. 1 The most common injury is myocardial contusion, which occurs in approximately 24% of cases. The anterior location of the right atrium and ventricle within the mediastinum is the leading risk factor for severe compression and contusion during chest trauma.…”

“…The anterior location of the right atrium and ventricle within the mediastinum is the leading risk factor for severe compression and contusion during chest trauma. 1,4,9 Heart valve injuries resulting in acute valvar insufficiency are uncommon complications of BCT. Postmortem reports showed an incidence of 5% for valve lesions after blunt cardiac injury.…”

“…Motor vehicle accidents represent the most common cause of significant thoracic injury among emergency department patients. 1 The incidence of cardiac injuries ranges from 20% to 76% in individuals involved in this type of trauma. 2 Heart valve injury is an unusual finding after blunt cardiac injury.…”

Experimental induction of blunt chest trauma in mice: A modified approach with evaluation in dummies and cadavers

“…Blunt chest trauma leads to death in up to 60% of patients after car accidents (1). Small and large animal models of blunt chest trauma are necessary to develop novel therapeutic approaches.…”