Isolated right atrial rupture from blunt trauma: a case report with systematic review of a lethal injury
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(2019) 14:28
CASE REPORT
Open Access
Isolated right atrial rupture from blunt trauma: a case report with systematic review of a lethal injury Tareq Maraqa1*, Mohamed A. T. Mohamed2, Kenneth L. Wilson3, Vinu Perinjelil1, Gul R. Sachwani-Daswani1 and Leo Mercer1
Abstract Background: Isolated right atrial rupture (IRAR) from blunt chest trauma is rare. There are no physical exam findings and non-invasive testing specific to the condition, which result in diagnostic delays and poor outcomes. We present a case of IRAR along with a systematic review of similar cases in the literature. Case report: A 23-year-old male presented following a motor vehicle accident (MVA). He was bradycardic and hypotensive during transportation; and required intubation. There were contusions along the right chest wall with clear breath sounds, and no jugular venous distension, muffled heart sounds. Hemodynamic status progressively worsened, ultimately leading to his death. However, no external sources of bleeding or evidence of cardiac tamponade was found. Methods: A search of PubMed, Ovid, and the Cochrane Library using: (Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right Atrium OR Right Atrial). Articles were included if they were original articles describing cases of IRAR. Results: Forty-five reports comprising seventy-five (n = 75) cases of IRAR. Conclusion: IRAR most commonly occurs following MVAs as the result of blunt chest trauma. Rupture occurs at four distinct sites and is most commonly at the right atrial appendage. IRAR is a diagnostic challenge and requires a high index of suspicion, as patients’ hemodynamics can rapidly deteriorate. The presentations vary depending on multiple factors including rupture size, pericardial integrity, and concomitant injuries. Cardiac tamponade may have a protective effect by prompting the search for a bleeding source. A pericardial window can be diagnostic and therapeutic in IRAR. Outcomes are favourable with timely recognition and prompt surgical intervention. Keywords: Isolated right atrial rupture, Blunt chest trauma, Cardiac rupture, Blunt cardiac rupture
Introduction Isolated right atrial rupture (IRAR) is a rare injury that occurs secondary to blunt chest trauma. Blunt cardiac rupture (BCR) of the right atrium (RA) has a reported incidence between 0.2–0.5% and occurs concomitantly with BCR of another cardiac chamber [1–3]. Only 10% of patients survive long enough to make it to a hospital [3]. IRAR has heterogeneous clinical manifestations and
* Correspondence: [email protected] 1 Trauma Department, Hurley Medical Center, One Hurley Plaza, Flint, MI 48503, USA Full list of author information is available at the end of the article
non-specific laboratory test findings which can delay time for life-saving interventions [4–6]. Due to the paucity in available literature, our knowledge of the condition is limited however cases of IRAR are more commonly encountered than previously thought. Herein, we present a case of IRAR following blunt chest trauma. We also conducted
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