Cardiac Herniation Due to Blunt Trauma: Early Diagnosis Facilitated by CT

Wielenberg, A; Demos, Terrence C; Luchette, Fred A.; Bova, Davide

doi:10.2214/ajr.05.1785

Cited by 11 publications

(11 citation statements)

References 3 publications

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“…Findings may include: cardiac silhouette may be unusually prominent ("boot shaped") and demarcated from the diaphragm; pneumopericardium; pneumomediastinum; bowel gas/loops within pericardial sac; prominent pulmonary artery contour; herniation and rotation of the heart into either hemithorax with a possible pericardial sac contour visible distinct to the cardiac silhouette [2,8,10,13]. Associated injuries include haemopneumothoraces, pulmonary contusions, lower lobe collapse/atelectasis/consolidation, surgical emphysema, rib/clavicle/sternal and thoracic spine fractures [13-15]. …”

Section: Discussionmentioning

confidence: 99%

“…• Transthoracic/oesophageal echocardiography and Focused Assessment with Sonography for Trauma - TTE/TOE have been used with varying reports of success but the sensitivity for diagnosing even large pericardial defects is thought to be low [7,15]. With the presence of surgical emphysema and pneumopericardium, the echographic windows will be poor and, along with operator variability, cannot be relied upon [15].…”

Section: Discussionmentioning

confidence: 99%

“…With the presence of surgical emphysema and pneumopericardium, the echographic windows will be poor and, along with operator variability, cannot be relied upon [15]. The importance of echocardiography lies in its ability to rule out other differential diagnoses (such a cardiac contusion or pericardial effusion and possible tamponade) non-invasively and quickly.…”

Section: Discussionmentioning

confidence: 99%

“…• Computed Tomography (CT) - along with its increasing availability and use in the multiply injured trauma patients, CT is also more sensitive for identifying cardiac axis changes and pericardial discontinuity than plain radiographs [13,15]. …”

Section: Discussionmentioning

confidence: 99%

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Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

Sherren

Galloway

Healy

2009

Scand J Trauma Resusc Emerg Med

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BackgroundBlunt Traumatic Pericardial Rupture (BTPR) with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%.MethodsWe present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injuryConclusionBTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with:Cardiovascular instability with no obvious causeProminent or displaced cardiac silhouette and asymmetrical large volume pneumopericardiumPotentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

Sherren

Galloway

Healy

2009

Scand J Trauma Resusc Emerg Med

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“…Some injuries may occur in varying magnitudes, but their extent reaches far beyond the original scope of the injury. [11121314] Others explained it as an external force with the secondary rise to the intrathoracic pressure creating stress on the cardiac tissue. [12] The stressful impact of trauma causes a surge of catecholamines release that can cause myocyte injuries, coronary spasm, or thrombosis.…”

Section: Blunt Cardiac Injurymentioning

confidence: 99%

Traumatic blunt cardiac injuries: An updated narrative review

Fadel

El‐Menyar

ElKafrawy

et al. 2019

Int J Crit Illn Inj Sci

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Blunt cardiac injury (BCI) is defined as injuries sustained due to blunt trauma to the heart, and it remains unchanged for long time. The spectrum of BCI ranges from a minor “bruise” to specific postcontusion cardiac conditions such as free-wall rupture. This is a narrative review provides a continued and updates details regarding BCIs from 2008 to 2017. For this purpose, a narrative review of literature was conducted using appropriate database for retrieval of articles through systematic search methodology. Autopsy-based studies are very limited. It can be concluded that regardless of the variability in the spectrum of modalities and medical/surgical resources, BCIs diagnosis and management remain a puzzle and needs further prospective studies.

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