Penetrating pediatric cardiac trauma caused by fall on a pencil with normal echocardiography

Abstract

A toddler, age 2, presented with a penetrating cardiac trauma caused by a fall on a pencil. This case showed a normal echocardiography. However, during removal of the pencil, signs of cardiac tamponade were noticeable. Thus, a normal echocardiography is no guarantee to exclude a possible penetrating cardiac injury.

An unusual presentation of foreign body superior mediastinum: a case report

“…Jan De Raet et al [3], presented a case of penetrating paediatric cardiac trauma caused by fall on a pencil with normal echocardiography.…”

Missed stabbed heart in an infant

“…1 Penetrating injuries to the heart are exceptionally rare in children, with sporadic case reports in the literature. 2 The diagnosis of a stabbed heart can be notoriously difficult, even in adults. In children the diagnosis is even more difficult and the recommended diagnostic pathway includes echocardiography, pericardiocentesis, subxyphoid window and explorative thoracotomy.…”

“…Some advocate blind removal of the foreign body with equipment and personnel on site in case the patient decompensates. 2 Others advocate an open thoracotomy and a heart-lung machine on stand-by. 3 Whatever the preferred method, there can be little doubt that these cases need expertise and referral to a specialist center which is advocated in all cases.…”

Traumatismo cardíaco penetrante en pediatría: presentación de caso, Hospital Infantil Dr. Robert Reid Cabral (HIRRC), República Dominicana

“…El diagnóstico de un trauma cardíaco penetrante inicia con la sospecha clínica, pero aún no existen criterios diagnósticos claros para este tipo de emergencias 1,2,9 . En pacientes hemodinámicamente estables, el ecocardiograma es el estudio de elección Cristina Contreras, Lisandra Corona, Norys Domínguez, Carolina Almonte, Ernesto Taveras, Ricardo Rojas y Miguel Mejía-Sang para detectar la severidad de la herida cardíaca, con una sensibilidad de 90 % y especificidad de 97 % 2,9 .…”

“…El manejo de los traumatismos penetrantes del corazón es multidisciplinario, pero el tratamiento definitivo lo constituye la cardiorrafia a través de toracotomía o esternotomía 10,11 . La reanimación, la intervención quirúrgica inmediata, un apoyo intensivo perioperatorio enérgico, son factores fundamentales en el manejo de los casos de herida penetrante cardíaca y pueden disminuir significativamente la mortalidad de estos pacientes a un 3.4 % 3,9,11,12 .…”