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

Kaul P, Somsekhar G, Macauley G - J Cardiothorac Surg (2006)

Bottom Line: 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 successfully operated upon.

Affiliation: Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, Leeds, UK. pankaj.kaul@leedsth.nhs.uk

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 successfully operated upon.

Chest radiograph showing a) left hemothorax and enlarged cardiac silhouette b) residual hemothorax and persistent enlarged cardiac silhouette after pleural tube drainage.
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Figure 1: Chest radiograph showing a) left hemothorax and enlarged cardiac silhouette b) residual hemothorax and persistent enlarged cardiac silhouette after pleural tube drainage.

Mentions: A 55 year old man presented to the accident and emergency department of a district general hospital after having fallen 3 metres from a ladder while cutting his garden hedge. He complained of left sided chest pain and worsening shortness of breath and dizziness. On examination, HR was 155/min, RR 37/min, BP 99/66 mm Hg, and JVP 5 cms above sternal angle. 5th and 6th ribs were tender but there was no obvious crepitus. Breath sounds were diminished in the left base. Chest x-ray revealed fractures of 5th and 6th ribs, a large left hemothorax and enlarged cardiac silhouette (Fig 1a). An intercostal drain was inserted which drained 1 lit of fresh blood but a follow up chest x-ray continued to show a large cardiac shadow (Fig 1b). A CT scan of chest revealed a 2 cm hemopericardium (2a) and residual left pleural blood and clot (Fig 2b). He was transferred to our regional cardiothoracic centre for further management. A transthoracic echocardiogram on arrival confirmed a global pericardial effusion with early tamponade.

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

Kaul P, Somsekhar G, Macauley G - J Cardiothorac Surg (2006)

Chest radiograph showing a) left hemothorax and enlarged cardiac silhouette b) residual hemothorax and persistent enlarged cardiac silhouette after pleural tube drainage.
© Copyright Policy - open-access
Figure 1: Chest radiograph showing a) left hemothorax and enlarged cardiac silhouette b) residual hemothorax and persistent enlarged cardiac silhouette after pleural tube drainage.
Mentions: A 55 year old man presented to the accident and emergency department of a district general hospital after having fallen 3 metres from a ladder while cutting his garden hedge. He complained of left sided chest pain and worsening shortness of breath and dizziness. On examination, HR was 155/min, RR 37/min, BP 99/66 mm Hg, and JVP 5 cms above sternal angle. 5th and 6th ribs were tender but there was no obvious crepitus. Breath sounds were diminished in the left base. Chest x-ray revealed fractures of 5th and 6th ribs, a large left hemothorax and enlarged cardiac silhouette (Fig 1a). An intercostal drain was inserted which drained 1 lit of fresh blood but a follow up chest x-ray continued to show a large cardiac shadow (Fig 1b). A CT scan of chest revealed a 2 cm hemopericardium (2a) and residual left pleural blood and clot (Fig 2b). He was transferred to our regional cardiothoracic centre for further management. A transthoracic echocardiogram on arrival confirmed a global pericardial effusion with early tamponade.

Bottom Line: 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 successfully operated upon.

Affiliation: Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, Leeds, UK. pankaj.kaul@leedsth.nhs.uk

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 successfully operated upon.

View Similar Images In: Results  - Collection
View Article: PubMed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=1459158&rFormat=json&query=null&req=5