Blunt Force Thoracic Trauma: A Case Study of Pericardial Rupture and Associated Cardiac Herniation

Abstract

Pericardial rupture, with associated cardiac herniation, is generally fatal. Diagnosis is difficult and frequently missed due to the subtlety of identifying characteristics. We report a case of a left sided pericardial rupture and cardiac herniation resulting from a high speed motorcycle collision. This report describes the course of treatment from the emergent admission to the diagnosis of the pericardial tear to retrospective CT analysis and rupture identification. In addition the difficulties of initial diagnosis, key symptoms, and identification of CT images are presented and discussed.

An uncommon potentially lethal injury: Traumatic pericardial rupture with herniation of the heart

“…As Glotzer et al. 2 have suggested, the mechanism of cardiac herniation in our patient was probably the atelectasis of the left lower lobe which developed at the time of injury, which did not resolve despite relief of tension pneumothorax and insertion of chest drains. This would have allowed the heart to herniate into the newly created space in the left pleural cavity.…”

Blunt Thoracic Trauma-Induced Mitral Papillary Muscle Avulsion with Pericardial Rupture and Cardiac Herniation: Difficult and Delayed Diagnoses

“…Cardiac herniation occurs in 0.4% of trauma and mortality ranges from 50% to 100% [2,7]. The lethality of cardiac herniation is postulated to be caused by torsion and occlusion of the great vessels and is more common with leftward herniation of the heart [8].…”

“…In addition, the diagnosis of such injuries can be significantly delayed secondary to the presence of other injuries. The diagnoses of these entities should be considered in BTT patients who have the following findings: hemodynamic instability, elevated jugular venous pressure, alternating heart tones, pulse, and blood pressures that change dramatically with body position shifts, characteristic murmur of mitral insufficiency, and water wheel or "bruit de moulin" like heart tones [5,8,10,11,[14][15][16]. Although radiologic investigation is not sensitive, the literature indicates that certain findings on the chest X-ray, CT, and echocardiography are able to detect herniation [17][18][19].…”

Delayed Presentation of Traumatic Pericardial Rupture: Diagnostic and Surgical Considerations for Treatment

“…In a series of trauma victims who survived the initial insult and were diagnosed with pericardial rupture, mortality was high (25%), likely due to associated injuries and cardiac contusion [Janson 2003]. The major concern associated with pericardial rupture is cardiac herniation and death, occurring due to torsion or incarceration of the great vessels, leading to cardiopulmonary collapse [Glotzer 2014].…”