Successful diagnosis of pericardial rupture caused by blunt chest trauma using contrast ultrasonography

Abstract

A 65-year-old male developed acute myocardial infarction due to coronary artery dissection and tricuspid valve injury after blunt chest trauma. Acute myocardial infarction was treated by coronary artery intervention; however, refractory heart failure with pleural effusion remained. The first transthoracic echocardiography (TTE) on admission failed to clearly visualize the tricuspid valve and right ventricle due to poor image quality. A follow-up TTE with contrast ultrasonography revealed pericardial rupture in addition to tricuspid regurgitation. Ruptures of the tricuspid papillary muscle and pericardium were confirmed during surgery and were repaired successfully. Blunt chest trauma results in various cardiac injuries including cardiac rupture, intramural hematoma, valvular injury, coronary artery injury, and electrical disturbances, leading to critical conditions and high mortality. Of such blunt trauma-induced injuries, coronary artery dissection, tricuspid valve injury, and pericardial rupture caused by blunt chest trauma are rare, and simultaneous occurrence of the three types of injuries that were successfully repaired has not been reported. In addition, this case indicates the utility of contrast ultrasonography for diagnosis of pericardial rupture caused by blunt chest trauma.

Prevalence of pericardial effusion in systemic diseases

“…The prevalence was 87 % and from 12 to 20 %, respectively. 12 In Mexico, we found them as the second cause of PE in 73 patients (19.2 %), which is similar to reports in the literature. In patients with heart failure, the causes of PE included the reabsorption ability of the lymphatic system and lymphatic drainage obstruction.…”

“…In patients with heart failure, the causes of PE included the reabsorption ability of the lymphatic system and lymphatic drainage obstruction. [12][13][14][15][16][17][18][19][20] Thyroid hormone dysfunction was associated with cardiovascular manifestations, 11 including subclinical hypothyroidism-related PE; in our study, only two patients with this pathology were identified. 21 In our series, only one case of PE due to iatrogenesis was recorded: one patient scheduled for surgery in whom a subclavian catheter was placed and had perforation of the right atrium, which caused PE and tamponade, thus requiring pericardiocentesis and catheter removal; the perforation closed spontaneously and no surgical treatment was necessary.…”

“…Inflammatory causes include viral, bacterial, mycotic and parasitic infections, [3][4][5] as well as cardiac injury syndromes after pericardiectomy, infarction or electrophysiological study, 3 autoimmune of the type systemic lupus erythematosus, 6 Sjögren's syndrome, rheumatoid arthritis 7 or metabolic diseases, such as uremic pericarditis. 8,9 Non-inflammatory causes include neoplastic, 10 metabolic 11 and traumatic 12 etiologies, as well as lymphatic drainage reduction. 12 The purpose of this study was to know the prevalence of PE associated with systemic diseases.…”

“…8,9 Non-inflammatory causes include neoplastic, 10 metabolic 11 and traumatic 12 etiologies, as well as lymphatic drainage reduction. 12 The purpose of this study was to know the prevalence of PE associated with systemic diseases.…”

Blunt Thoracic Trauma-Induced Mitral Papillary Muscle Avulsion with Pericardial Rupture and Cardiac Herniation: Difficult and Delayed Diagnoses

“…Although radiologic investigation is not sensitive, the literature indicates that certain findings on the chest X-ray, CT, and echocardiography are able to detect herniation [17][18][19]. Various radiological modalities, Case Reports in Surgery including contrast ultrasonography and CT have been proposed to be able to identify pericardial rupture, but no specific findings or algorithm has been described [9,11,20,21]. We present this case as an example of the protean nature of BTT and three of its sequelae that are feared not only because of their high mortality but also difficult preoperative diagnoses.…”