Delayed diagnosis of cardiac tamponade following isolated blunt abdominal trauma

Abstract

Traumatic haemopericardium is an uncommon but life threatening condition. It is usually caused by penetrating cardiac injuries or cardiac rupture from blunt chest trauma. We report haemopericardium and cardiac tamponade in a young girl after blunt abdominal trauma. She presented with mild upper abdominal pain, tachycardia and hypotension having been kicked in the abdomen by a horse. No damage was found at laparotomy and she remained haemodynamically unstable. Further investigation found cardiac tamponade and haemopericardium. This was managed by insertion of a pericardial drain using transthoracic echocardiogram guidance, with later drainage in the operating theatre using guidance with a transoesophageal echocardiogram.

Pericardial Tamponade With a Positive Abdominal FAST Scan in Blunt Chest Trauma

“…2,3 The true incidence of cardiac trauma after blunt injury is unknown, but cases of blunt cardiac trauma requiring treatment may be as low as 2.6 to 4.5%, 3 and this can lead to a delay in considering the diagnosis. 4,5 In the emergency room the FAST scan pericardial window should help in the diagnosis of a tamponade. Rozycki et al used ultrasound to scan for pericardial fluid in 1,540 patients with truncal injuries.…”

Ultrasound-diagnosed cardiac tamponade after blunt abdominal trauma—treated with emergent thoracotomy

“…Only one survived, and he was labeled a neurologic invalid (28). There have been reports of patients with pericardial tamponade secondary to blunt chest trauma as well as secondary to blunt abdominal trauma who have survived with good outcomes (32,33). In the group described by Schiavone et al, 2 of 3 patients survived after release of cardiac tamponade, accomplished via ED thoracotomy (32).…”

Notorious Pitfalls in the Care of Multi-Trauma Patients

“…It is usually caused by penetrating cardiac injury or cardiac chamber rupture after blunt chest trauma (13). A haemopericardium can comprise the blood flow to the ventricles and lead to a decreased cardiac output, ultimately resulting in death due to pump failure.…”

“…Multiple reviews show that up to 80% of pericardial tamponades were initially missed in centres with experience (13,14). A haemopericardium therefore necessitates clinical experience and a high degree of suspicion.…”