Missed stabbed heart in an infant

As, A B van; Brink, Johan

doi:10.1016/j.injury.2005.03.018

Cited by 1 publication

(2 citation statements)

References 5 publications

(4 reference statements)

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“…Management of penetrating cardiac injuries depends upon the stability of the patient at presentation, and includes methods ranging from emergency-department thoracotomy, to in-theatre thoracotomy or median sternotomy 13 . Despite cases such as ours, where removal of the penetrating object did not cause any bleeding, 10 , 11 removal of the thorn without detailed investigation followed by median sternotomy could result in uncontrolled bleeding or cardiac tamponade 9 . We suggest that the mortality risk reduction of an extraction under full control warrants the minor morbidity of a median sternotomy.…”

Section: Discussionmentioning

confidence: 96%

“…Isolated case reports describe injuries by projectiles (air rifles), 5–7 a crotchet hook, 8 a pencil, 9 and a sewing needle 10 . An unusual case at RCCH described a stab injury with pericardial and myocardial laceration without penetration) 11 . An 11-year retrospective study 3 showed 32 out of 4569 (0.7%) children admitted for trauma had penetrating cardiac injuries, of which 81% were stab wounds.…”

Section: Discussionmentioning

confidence: 99%

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Uneventful survival of a rural child after penetrating cardiac injury by a thorn: a case report

Decker

Delft

et al. 2019

European Heart Journal - Case Reports

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Background Paediatric penetrating cardiac injury is extremely rare, precluding published management guidelines, therefore warranting a case-by-case approach with learning points gleaned from each case. Case summary A 7-year-old boy presented to a rural hospital with a stab wound to the chest by a Withaak (Vachellia tortilis) thorn. The patient was haemodynamically stable on presentation, but a 2 cm subcutaneous, pulsatile mass was present at the cardiac apex. Echocardiography revealed a foreign body penetrating from the apex into the heart, with evidence for a fistula between a cardiac chamber and the pulsatile mass. Angiography confirmed the existence of the fistula between the right ventricle (RV) and the pulsatile mass. A controlled extraction under general anaesthaesia via median sternotomy was performed in-theatre, with blood products and cardiac bypass on standby. The patient recovered without complications and was discharged after 4 days. Discussion Our case illustrates the limitations of echocardiography in identifying the precise anatomical definition of penetrating cardiac injuries. Angiography is therefore indicated in such cases. The injury to the RV and the haemostatic effects of the in situ thorn were favourable prognostic factors. We believe that the mortality risk reduction of extraction under full control warrants the minor morbidity of a median sternotomy.

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