Ann Thorac Surg 2007;83:1554
© 2007 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Traumatic Rupture of the Pericardium
Matthew M. Carrick, MDa,*,
Hoang Q. Pham, MDa,
Bradford G. Scott, MDa,
Matthew J. Wall, Jr, MDb
a Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
b Cardiothoracic Division, Baylor College of Medicine, Houston, Texas
* Address correspondence to Dr Carrick, Baylor College of Medicine, Michael E. DeBakey, Department of Surgery, One Baylor Plaza, Houston, TX 77030 (Email: mcarrick{at}bcm.edu).
A 79-year-old man was brought to the emergency room after a high-speed motor vehicle collision. His workup revealed multiple rib fractures, pneumomediastinum, pneumothorax, intraabdominal free air and a transected aorta. A computed tomographic scan of his chest was significant for a periaortic hematoma, pneumopericardium, and a pneumothorax. Thoracic arteriogram confirmed the aortic transection distal to the take-off of the left subclavian artery (Fig 1). He remained hemodynamically stable and was taken to the operating room for repair of his transected thoracic aorta and exploratory laparotomy. On exploration of his thoracic cavity for repair of his aorta he was noted to have a ruptured pericardium (white arrows) when the lung was retracted posteriorly (Fig 2). This pericardial laceration tracked through the diaphragm and most likely accounted for the free abdominal air. The exploratory laparotomy was otherwise negative.
Rupture of the pericardium is a rare phenomenon in trauma. The actual incidence is unknown. Some patients are asymptomatic, but many patients with this injury never make it to the hospital. Diagnosis of a ruptured pericardium is sometimes made during resuscitative thoracotomy, and the only clue may be changes in hemodynamic stability upon changes in patient position [1]. In the largest series of these injuries, 72% were due to motor vehicle collisions. Similar to this case, 64% of ruptures occurred in the left pleuropericardium [2].
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References
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- Wall Jr MJ, Mattox KL, Wolf DA. The cardiac pendulum: blunt rupture of the pericardium with strangulation of the heart J Trauma 2005;59:136-142.[Medline]
- Fulda G, Rodriguez A, Turney SZ, Cowley RA. Blunt traumatic pericardial ruptureA ten year experience 1979–1989. J Cardiovasc Surg (Torino) 1990;31:525-530.[Medline]
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