Pericardial injury after motor vehicle accident
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CASE REPORT
Pericardial injury after motor vehicle accident Benjamin Ross Zambetti 1 & Caroline Nicole Hymel Brown 2 & Peter Edmund Fischer 1,3 & Alim Khandekar 1,4 & Ganpat Shivrai Valaulikar 1,4,5 Received: 28 April 2020 / Revised: 17 June 2020 / Accepted: 23 June 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Pericardial rupture is rare after blunt thoracic trauma and is associated with significant mortality. Mesh repair is recommended to prevent cardiac herniation and strangulation. Keywords Pericardium . Trauma . Blunt trauma . Pericardial rupture
Introduction Blunt chest trauma is associated with significant morbidity. One rare entity with blunt trauma is pericardial rupture which can lead to cardiac herniation or strangulation and sudden cardiac death. This case represents a patient with a heavy trauma burden, who was found to have a large pericardial injury, which was repaired with mesh.
Case report This patient is a 33-year-old African American male with no significant past medical history, who presented to the trauma center after a high-velocity motor vehicle accident. He was intubated at the scene of the accident due to combativeness
and for pain control of his obviously deformed right leg. He was admitted to the trauma center where he was found to have right ribs 10–11 fractured, an open right femur fracture, a right tibial plateau fracture, a right ulna fracture, and a grade 3 liver laceration on his admission imaging, which included a contrast computed tomography (CT) scan of the chest, abdomen, and pelvis. He was taken to the operating room by orthopedics and his long bone fractures were repaired over the first 2 days of his hospitalization. His liver laceration was managed non-operatively, per protocol, without complication. On hospital day 3, he was extubated and weaned to minimal supplemental oxygen. On hospital day 4, the patient had an episode of acute chest pain and a portable chest x-ray was performed (Fig. 1). Because of concern for a missed diaphragm injury, which was not visible
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12055-020-01000-4) contains supplementary material, which is available to authorized users. * Ganpat Shivrai Valaulikar [email protected] 1
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
2
College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
3
Division of Trauma/Critical Care, University of Tennessee Health Science Center, Memphis, TN, USA
4
Division of Cardiothoracic Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
5
Veterans Affairs Medical Center Memphis, 1030 Jefferson Ave, Memphis, TN 38104, USA
Fig. 1 Chest X-ray after extubation with herniation of intra-abdominal contents
Indian J Thorac Cardiovasc Surg
on his admission CT scan, he was taken to the operating room for diagnostic laparoscopy (Video 1, Fig. 2) which was converted to exploratory laparotomy, where his diaphragm
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