Delayed cardiac tamponade in a patient with previous minor blunt chest trauma

Hermens, Jeannine A.J.M.; Wajon, Elly M.C.J.; Grandjean, Jan G.; Haalebos, M.M.P.; Birgelen, Clemens von

doi:10.1016/j.ijcard.2007.07.080

Cited by 22 publications

(17 citation statements)

References 5 publications

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“…Another patient had end‐stage pleural mesothelioma and died shortly after the pericardiocentesis, thus the cytology result was deemed not to have therapeutic implications. The fourth case was a late‐onset pleural and pericardial effusion requiring pericardiocentesis in an adolescent patient after a polytraumatic road traffic injury 23. On aggregate, cytological analysis was requested for nearly all patients for whom it was deemed necessary.…”

Section: Discussionmentioning

confidence: 99%

Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

Strobbe

Adriaenssens

Bennett

et al. 2017

JAHA

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BackgroundPericardial effusions can be caused by a variety of disorders. The frequency of the underlying diseases varies with patient population; therefore, previously reported series are not necessarily representative of other populations. Our purpose was to examine the etiology of pericardial effusions and the survival of patients requiring pericardiocentesis at a tertiary center.Methods and ResultsWe performed a retrospective observational study of 269 consecutive patients who underwent percutaneous pericardiocentesis at our university hospital between 2006 and 2016 and had prospective follow‐up for up to 10 years. The most frequent etiologies were idiopathic (26%), malignancy (25%), and iatrogenicity (20%), whereas bacterial causes were very rare. The most frequent malignancies originated from the lung (53%) or breast (18%). A new cancer was diagnosed with malignant pericardial effusion as the presenting complaint for 9% of patients, whereas the pericardium was the first metastatic site of a known malignancy in 4% of patients. Survival was significantly poorer in malignancy‐related versus non–malignancy‐related effusions (P<0.001) and in cytology‐positive versus cytology‐negative effusions in the overall cohort (P<0.001). Among cancer‐only patients, however, there was no significant difference in long‐term survival between cytology‐positive and ‐negative effusions.ConclusionsIn this contemporary tertiary‐center cohort, pericardial effusions often represent the primary instance of a new malignancy, underscoring the importance of cytological analyses of noniatrogenic effusions in patients without known cancer, as survival is significantly worse. In cancer patients, however, the presence of pericardial malignant cytology does not appear to affect outcome significantly.

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Section: Discussionmentioning

confidence: 99%

Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

Strobbe

Adriaenssens

Bennett

et al. 2017

JAHA

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“…Case reports suggest that even apparently minor blunt chest trauma may produce significant post-traumatic effusion or delayed bleeding and later tamponade. 6, 7 As a result, surgical drainage has been advocated for patients found to have pericardial fluid following blunt trauma. 4, 8, 9 Still, studies of Focused Assessment with Sonography for Trauma (FAST) and CT have shown that pericardial fluid in trauma patients is not always clinically significant.…”

Section: Introductionmentioning

confidence: 99%

Management of pericardial fluid in blunt trauma

Witt

Linnau

Maier

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background The objectives of this study were to assess current variability in management preferences for blunt trauma patients with pericardial fluid, and to identify characteristics associated with operative intervention for patients with pericardial fluid on admission computed tomography (CT) scan. Methods This was a mixed-methods study of blunt trauma patients with pericardial fluid. The first portion was a research survey of members of the Eastern Association for the Surgery of Trauma conducted in 2016, in which surgeons were presented with four clinical scenarios of blunt trauma patients with pericardial fluid. The second portion of the study was a retrospective evaluation of all blunt trauma patients ≥14 years treated at our Level I trauma center between 1/1/2010 and 11/1/2015 with pericardial fluid on admission CT scan. Results For the survey portion of our study, 393 surgeons responded (27% response rate). There was significant variability in management preferences for scenarios depicting trace pericardial fluid on CT with concerning hemodynamics, and for scenarios depicting hemopericardium intraoperatively. For the separate retrospective portion of our study, we identified 75 blunt trauma patients with pericardial fluid on admission CT scan. Seven underwent operative management; six of these had hypotension and/or electrocardiogram changes. In multivariable analysis, pericardial fluid amount was a significant predictor of receiving pericardial window (relative risk for one category increase in pericardial fluid amount: 3.99, 95% CI 1.47-10.81) but not of mortality. Conclusions There is significant variability in management preferences for patients with pericardial fluid from blunt trauma, indicating a need for evidence-based research. Our institutional data suggest that patients with minimal to small amounts of pericardial fluid without concerning clinical findings may be observed. Patients with moderate to large amounts of pericardial fluid who are clinically stable with normal hemodynamics may also appear appropriate for observation, although confirmation in larger studies is needed. Patients with hemodynamic instability should undergo operative exploration. Level of Evidence Level IV, Therapeutic/Care Management

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“…The mechanisms by which blunt chest trauma can induce hemopericardium are pericardial or myocardial contusion, aortic root rupture, or diffuse myocardial hemorrhage. 11,12 We assume that the pericardial or vessel injury occurred at the time of the fall. The injured sites may have initially been healed by a clot, but subsequent dislodgement of the clot irritated the surrounding labile tissues, resulting in pericardial hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Simultaneously diagnosed pulmonary thromboembolism and hemopericardium in a man with thoracic spinal cord injury

Han

Seon

Choi

et al. 2012

The Journal of Spinal Cord Medicine

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Background: Simultaneous pulmonary thromboembolism (PTE) and hemopericardium is a rare but lifethreatening condition. As hemopericardium is a contraindication to anticoagulation treatment, it is challenging to handle both conditions together. Objective: The objective of the study was to report a rare case of a man with thoracic spinal cord injury presenting with simultaneous PTE and hemopericardium. Design: Case report. Subject: A 43-year-old man with incomplete T9 paraplegia (American Spinal Injury Association Impairment Scale D) complained of fever one and a half months after spinal cord injury sustained in a fall. Findings: During evaluation of fever origin, chest computed tomography and transthoracic echocardiogram revealed simultaneous PTE and hemopericardium. After serial echocardiograms over 2 days demonstrated stability, intravenous heparin, and oral warfarin were administered and his medical status was observed closely. Ultimately, both conditions improved without significant complications. Conclusion: We report successful treatment of man with acute spinal cord injury who presented with simultaneously diagnosed PTE and hemopericardium, a rare complication involving two distinct and opposing pathological mechanisms and conflicting treatments.

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Delayed cardiac tamponade in a patient with previous minor blunt chest trauma

Cited by 22 publications

References 5 publications

Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

Etiology and Long‐Term Outcome of Patients Undergoing Pericardiocentesis

Management of pericardial fluid in blunt trauma

Simultaneously diagnosed pulmonary thromboembolism and hemopericardium in a man with thoracic spinal cord injury

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