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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.

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.

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