Secondary left ventricular injury with haemopericardium caused by a rib fracture after blunt chest trauma

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Abstract

Trauma is the third most common cause of death in the West. In the US, approximately 90,000 deaths annually are traumatic in nature and over 75% of casualties from blunt trauma are due to chest injuries. Cardiac injuries from rib fractures following blunt trauma are extremely rare. We report the unusual case of a patient who fell from a height and presented with haemopericardium and haemothorax as a result of left ventricular and lingular lacerations and was sucessfully operated upon.

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Blunt traumatic cardiac rupture. A 5-year experience.

C. Brathwaite, Chris Turney, Thelma R Cowley … (1990)

Blunt traumatic cardiac rupture is associated with a high rate of mortality. A review of the computerized trauma registry (1983 to 1988) identified 32 patients with this injury (ages 19 to 65 years; mean age, 39.5 years; 21 men and 11 women). Twenty-one patients (65.6%) were injured in vehicular crashes, 3 (9.4%) in pedestrian accidents, 3 (9.4%) in motorcycle accidents; 3 (9.4%) sustained crush injury; 1 (3.1%) was injured by a fall; and 1 (3.1%) was kicked in the chest by a horse. Anatomic injuries included right atrial rupture (13[40.6%]), left atrial rupture (8 [25%]), right ventricular rupture (10[31.3%]), left ventricular rupture (4[12.5%]), and rupture of two cardiac chambers (3 [9.4%]). Diagnosis was made by thoracotomy in all 20 patients presenting in cardiac arrest. In the remaining 12 patients, the diagnosis was established in seven by emergency left anterolateral thoracotomy and in five by subxyphoid pericardial window. Seven of these 12 patients (58.3%) had clinical cardiac tamponade and significant upper torso cyanosis. The mean Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Scale (GCS) score were 33.8, 13.2, and 14.3, respectively, among survivors and 51.5, 8.3, and 7.0 for nonsurvivors. The overall mortality rate was 81.3% (26 of 32 patients), the only survivors being those presenting with vital signs (6 of 12 patients [50%]). All patients with rupture of two cardiac chambers or with ventricular rupture died. The mortality rate from myocardial rupture is very high. Rapid prehospital transportation, a high index of suspicion, and prompt surgical intervention contribute to survival in these patients.

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Blunt cardiac rupture. The Emanuel Trauma Center experience.

Kyle Hill, M J Perchinsky, Russell Long (1995)

To analyze the factors affecting outcome in patients with blunt cardiac rupture, including anatomical cardiac injury, associated injury, clinical presentation, age, mechanism of injury, diagnostic method, surgical intervention, and presence of vital signs in the field and on arrival. Retrospective review. A community-based level I trauma center. A consecutive series of 27 patients seen between 1984 and 1993. Survival with return to preinjury activity. Eleven patients (41%) survived resuscitation, surgery, and initial hospital care. Survivors had a lower mean Injury Severity Score (38) than nonsurvivors (62) (P < .05). Three (33%) of nine patients who arrived with no blood pressure or viable electrical heart rhythm survived. No patient survived rupture of two cardiac chambers. Patients with blunt cardiac rupture who present with cardiac arrest can survive. Nonsurvivors tend to have more associated injuries, as indicated by higher Injury Severity Scores. Our institution's overall survival rate of 41% (11/27) compares favorably with rates at other trauma centers.

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Chest trauma. Approach and management.

J Calhoon, J Trinkle, Robert Grover (1992)

A synopsis of both blunt and penetrating thoracic trauma, this article outlines an approach to management for injuries to the lung, heart, esophagus, tracheobronchial tree, diaphragm, and major thoracic vessels. Also outlined are the management of rib fractures, scapula fractures, sternal fractures, and, in particular, flail chest with associated pulmonary contusion.

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Author and article information

Journal

Journal ID (nlm-ta): J Cardiothorac Surg

Title: Journal of Cardiothoracic Surgery

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-8090

Publication date Collection: 2006

Publication date (Electronic): 28 March 2006

Volume: 1

Page: 8

Affiliations

[1 ]Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, Leeds, UK

Article

Publisher ID: 1749-8090-1-8

DOI: 10.1186/1749-8090-1-8

PMC ID: 1459158

PubMed ID: 16722596

SO-VID: a550a688-a95c-43a4-a83d-d353ed776029

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Secondary left ventricular injury with haemopericardium caused by a rib fracture after blunt chest trauma

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Karger: Dermatology

Most cited references 10

Blunt traumatic cardiac rupture. A 5-year experience.

Blunt cardiac rupture. The Emanuel Trauma Center experience.

Chest trauma. Approach and management.

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