Severe Cardiac Rupture by Only One Blow to the Chest in a Young Boy: An Autopsy Case

Abstract

Cardiac rupture by blunt chest trauma is commonly seen after motor vehicle accidents and falls; however, it is rarely caused by a blow to the chest. We herein report an autopsy case of a high school boy who sustained severe right ventricular rupture by only one knee kick to the chest during a quarrel. He was hospitalized and developed cardiopulmonary arrest. Emergency surgery was performed, but the patient died. The autopsy revealed no external severe trauma or deformation, but the side wall of the right ventricle contained a large V‐shaped laceration. The other thoracic organs had no injuries. This case illustrates that severe cardiac rupture can occur by only one blow to the chest. Blunt cardiac injuries can occur even if no severe injuries are present on the body surface. We should consider the possibility of severe cardiac injuries regardless of the presence of external injuries.

Blunt cardiac rupture due to kicking on the lateral side of the right chest

“…Therefore, diagnosis was challenging in the present case, highlighting the fact that trauma severity does not necessarily indicate the degree of blunt cardiac injury. In our case, two possible mechanisms of right ventricular rupture were suspected, which was caused by compression between the sternum or the costal cartilages and spine, or by significant elevation of venous pressure by an intensive blow to thorax on squatting during playing . In both mechanisms, cardiac injury might be initially small; however, it shortly progressed to a severe injury as visible by the symptoms.…”

“…In our case, two possible mechanisms of right ventricular rupture were suspected, which was caused by compression between the sternum or the costal cartilages and spine, or by significant elevation of venous pressure by an intensive blow to thorax on squatting during playing. 2 In both mechanisms, cardiac injury might be initially small; however, it shortly progressed to a severe injury as visible by the symptoms. We recommend that blunt cardiac rupture should be suspected in patients with blunt trauma, even if the trauma is sustained during playing sports, and unexplained shock that is incompatible with apparent injuries or is persistent despite aggressive resuscitation, even if obvious cardiac destruction or massive pericardial effusion is not apparent on echocardiography.…”