Blunt Traumatic Pericardial Rupture: a Diagnostic Challenge

Abstract

Traumatic pericardial rupture is a rare lesion associated with a high mortality rate, and its diagnosis poses challenges for the surgeon. Two patients are presented, in whom the diagnosis was not possible preoperatively, and discovered only during surgery for associated lesions. To the best of our knowledge, this is the first description of total bilateral linear pericardial ruptures associated with traumatic aortic rupture. The mechanism, diagnostic challenges, and management of this rare entity are discussed.

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

“…Chest radiographs may demonstrate displacement of the cardiac silhouette, but with associated traumatic injuries, this may be challenging to appreciate. While increasing numbers of patients receive CT scans in the peri-trauma period, not all patients, like ours, will demonstrate pericardial injury at the time of initial imaging [Rashid 2003]. Additionally, echocardiography may be non-diagnostic, given the changes in cardiac orientation depending upon patient positioning.…”

Pericardiodiaphragmatic rupture and cardiac herniation after multiple blunt trauma: Diagnostic and therapeutic difficulties

“…If the pleural pericardium and diaphragm are injured, the heart might herniate into the pleural space, resulting in heart constriction, fatal strangulation, or even total torsion of the great vessels, resulting in sudden death. The diagnosis 1,4,5 is accomplished by means of chest radiography or CT when there is displacement of the heart. 5 Today, in stable patients video-assisted thoracoscopy (VATS) can be used.…”

“…The diagnosis 1,4,5 is accomplished by means of chest radiography or CT when there is displacement of the heart. 5 Today, in stable patients video-assisted thoracoscopy (VATS) can be used. Electrocardiographic signs are nonspecific for CH.…”

“…CT appears decisive in the diagnosis because it noninvasively visualizes the pericardium and reveals pericardial rupture. 5 When the diaphragmatic tear is large, the intestinal obstruction might never appear. The patient might demonstrate nonspecific abdominal and chest symptoms.…”

“…The patient might demonstrate nonspecific abdominal and chest symptoms. As a rule, all patients after severe blunt trauma should undergo CT 5 of the chest and echocardiography if plain chest radiographic examinations show an enlargement of the mediastinum.…”