Traumatic ciardiac rupture with acute ascites

Abstract

A rare accumulation of serous ascites following traumatic cardiac rupture is reported for a 21-year-old man transferred to the emergency center of our hospital from a community hospital suffering from severe shock due to a motorcycle accident. Computed tomography scan showed moderate pericardial and intrapelvic fluid accumulation strongly suggesting cardiac and visceral injuries. An emergency sternotomy disclosed a rupture of the right atrial appendage, successfully closed with primary sutures. A laparotomy was done to aspirate moderate serous fluid, which was clear and not bloody. Edema of the retroperitoneal space and hepatic congestion were noted with no accompanying organ injury. Ascites pathogenesis is unknown but appeared to be related to portal venous congestion induced by cardiac tamponade combined with massive intravenous fluid infusion done to correct the patient's deteriorating hemodynamics.

Rupture of the left atrial ‘basal’ appendage due to blunt trauma in an elderly patient

“…The mechanism of injury is thought to be compression of the chest cage that crushes the heart between the sternum and the vertebras dorsales or via direct transmission of a momentary increase in intrathoracic pressure to the heart chambers [4]. Several reports have noted that serous ascites following cardiac rupture due to blunt chest trauma is an incipient symptom [5,6]. Ascites resulting from mechanical impedance to the hepatic venous outflow has been documented in detail.…”

Computed tomography findings in acute decompensated heart failure: periportal collar sign and lymphedema in the hepatoduodenal ligament and retroperitoneal space

“…Koyama et al reported a case of traumatic cardiac rupture with acute ascites (Koyama et al 2000). In that article, an emergency sternotomy revealed a rupture of the right atrial appendage.…”