Blunt Cardiac Injury: Case Report of Salvaged Traumatic Right Atrial Rupture

Abstract

The incidence of cardiac rupture following blunt trauma is rare, occurring in 0.3%-0.5% of all blunt trauma patients. It can be fatal at the trauma scene, and is frequently missed in the emergency room setting. The severity of a cardiac trauma is based on the mechanism and degree of the force applied. The objective of this study was to report the case of a 32-year-old male patient who was involved in a motor vehicle collision and presented to the emergency room with signs of hypovolemic shock. The patient was found to have severe chest trauma associated with massive hemothorax requiring immediate intervention. The patient had an emergent thoracotomy revealing a right atrial injury. Repair of the atrial injury reversed the state of shock. The patient was discharged after 35 days of hospitalization in good condition.

Isolated Right Atrial Appendage Rupture from Blunt Chest Trauma: A Case Report

“…It is thought that the right atrium is a thin-wall structure that is susceptible to injury from blunt chest trauma, particularly in cases of high-impact trauma [4,5,13]. Theoretically, when faced with a case of blunt chest trauma associated with cardiac tamponade, and unstable hemodynamic status, one must immediately think of an intrathoracic surgical lesion (such as heart, great vessels) [1,6,7]. Cardiac rupture presents sometimes with massive hemothorax (in case of traumatic pericardiac laceration, postoperative pericardiotomy or traumatic associated rib fractures), and in this situation, it is difficult for the chest surgeon to estimate the origin of bleeding that suspects cardiac rupture, and as a result delayed diagnosis leads to poor prognosis [8,[14][15][16].…”

“…Moreover, the initial symptoms may be non-specific and can mimic other conditions and there is no universally accepted diagnostic criteria for the assessment of atrial rupture as there have been many documented presentations for such an injury in the literature [18]. The diagnosis of blunt cardiac injury remains difficult due to other associated injuries that divert the physician's attention, as well as the lack of specific physical findings and the lack of clinical suspicion of a specialized physician in an emergency room for the diagnosis of such an injury [10,6]. According to Muna Al Ayyan et al [6], it is worth mentioning that the experience of a general surgeon who works in a hospital lacking a surgical cardiovascular section plays a vital role in evaluating and determining the proper treatment for patients experiencing cardiac and/ or vascular issues.…”

“…According to many authors [10,6,9,12], imaging studies such as echocardiography, CT scans, and MRI can help confirm the diagnosis and determine the extent of the injury if the hemodynamic status is stable. This patient initially had a stable status that was permitted to carry out a thoracic CT scan with contrast agent showing the sign of extravasation into pericardial space that is extremely clear and specific sign of cardiac rupture.…”

“…Prompt diagnosis and treatment can improve the chances of survival by nearly 80% for patients suffering from this type of devastating injury [6]. In case of cardiac rupture suspected, median sternotomy is the approach most commonly utilized as it allows for quick, easy and adequate exposure of the heart and great vessels [3,10,11].…”

“…As compared to penetrating cardiac injuries, few blunt cardiac injuries make it to the hospital alive, and there is about 2.2% of blunt cardiac injuries reach the hospital alive as compared to 33.7% of penetrating cardiac injuries [2,3]. Blunt cardiac rupture of the right atrium has a reported incidence between 0.2-0.5% and occurs concomitantly with blunt chest trauma of another cardiac chamber [4][5][6]. Only 10% of patients survive long enough to make it to a hospital.…”