Delayed pericardial effusion and cardiac tamponade following penetrating chest trauma

Abstract

We present the case of a 20-year-old man who was stabbed in the left chest and was diagnosed with a large pericardial effusion by focused emergency department (ED) ultrasonography. After placement of a left chest tube for presumed tension pneumothorax, the pericardial effusion had resolved. The patient's postinjury course was complicated by pericarditis and recurrent tamponade, which required repeated pericardiocentesis for management. This case illustrates the role of focused ED ultrasonography for diagnosis of pericardial effusion in penetrating trauma and the potential for delayed pericardial effusion and tamponade in such patients. Although the pathophysiology of delayed pericardial effusion is unclear, autoimmune postpericardiotomy syndrome has been proposed as the cause of this rare condition. Our case underscores the importance of close monitoring of patients with known or suspected pericardial injuries due to their potential for the development of lifethreatening complications. RÉ SUMÉNous faisons é tat, dans le pré sent article, du cas d'un homme de 20 ans qui a reç u des coups de couteau dans le thorax gauche; une é chographie focalisé e, effectué e au service des urgences (SU) a permis de diagnostiquer un important é panchement pé ricardique. Aprè s la pose d'un drain thoracique à gauche pour traiter un pneumothorax à soupape pré sumé , l'é panchement pé ricardique s'est ré sorbé . Toutefois, la convalescence s'est compliqué e d'une pé ricardite et de tamponnades ré cidivantes, qui ont né cessité des ponctions pé ricardiques à ré pé tition. L'exposé de cas met en é vidence le rô le de l'é chographie au SU dans le diagnostic d'un é panchement pé ricardique consé cutif à une blessure pé né trante et le risque d'apparition tardive d'un é panchement pé ricardique et de tamponnade en pareilles circonstances. L'on ne connaît trè s bien le processus physiopathologique de l'é panchement pé ricardique, mais certains ont avancé le syndrome de postpé ricardiotomie auto-immune comme cause possible de cette affection rare. La description du cas fait ressortir l'importance de la surveillance é troite des patients chez qui il y a une pré sence pré sumé e ou avé ré e de lé sions pé ricardiques, en raison du risque d'apparition de complications potentiellement mortelles.

Sudden death associated with delayed cardiac rupture: case report and literature review

“…Delayed cardiac rupture is often associated with hemopericardium as bleeding into the pericardial sac. To better understand the fatal outcome of delayed chest trauma, we searched for delayed hemopericardium or cardiac tamponade in PubMed, and have summarized the literatures on negative or healed cardiac injuries in Table 2 (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44).…”

Delayed Tamponade after Traumatic Wound with Left Ventricular Compression

“…Penetrating cardiac trauma has a high mortality rate. While mortality has decreased with advances in emergency medical services [ 1 ], less than 10% will reach the hospital alive. Among the survivors that present to the emergency department, 70% will have evidence of acute tamponade.…”

“…Delayed cardiac tamponade is a well-described entity after both blunt [ 3 ] and penetrating trauma [ 1 ]. Pericardial effusion can be seen late in up to 22% of penetrating chest injuries [ 4 ] but luckily only a small fraction of these will present in clinical tamponade.…”

“…A diagnostic and therapeutic challenge: delayed cardiac tamponade can occur up to 100 days after the index injury, and it may have an atypical presentation [ 5 ]. The etiology of the late presentation is unclear, although several mechanisms have been proposed including clot sealing a partial tear that either allows a slow leak into the pericardial sac or suddenly dislodges leading to more rapid accumulation [ 3 ]; autoimmune pericarditis and subsequent pericardial effusion; and unidentified laceration of a coronary artery with subsequent spasm that later hemorrhages [ 1 ].…”