Delayed pericardial tamponade after penetrating chest trauma

Abstract

Delayed pericardial tamponade (PT) after penetrating heart trauma is now a rare condition as a result of advances in medical and surgical management. We report the case of a 32-year-old man with delayed PT after a stab wound from a knife. The initial evaluation was consistent with a traumatic apical myocardial infarction. After an uneventful initial course, the patient developed acute PT, which required emergency surgery. A thrombus was discovered over a laceration in the mid-segment of the left anterior descending artery and a simple suture was performed.

Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest

“…Since selective penetrating injuries to the coronary arteries are rare, accounting for less than 5% of all the penetrating cardiac injuries [9,10], coronary pseudoaneurysms caused by such injuries are even rarer. In addition, the occurrence of a delayed tamponade after coronary vessel injury is rare and usually coupled with many complications, including myocardial infarction, valvular injury, coronary-cameral fistula, and many others [11][12][13][14].…”

Delayed pericardial effusion and cardiac tamponade following penetrating chest trauma

“…2,6,[8][9][10] There have, however, been reports of normal imaging prior to effusion development. 9,10 Although the initial treatment of pericardial tamponade with volume resuscitation and effusion drainage is well known, the optimal definitive treatment of this condition remains unclear. The 24 patients described by Harris and colleagues underwent subxiphoid pericardial exploration, 5 whereas in the review by Aaland and Sherman, the 8 patients managed after 1950 were treated with thoracotomy, sternotomy, or repeated pericardiocentesis.…”

“…2 In many other reported cases, sternotomy or thoracotomy has been performed for definitive management. [6][7][8][9][10][11] In the case of our patient, management included placement of a pericardial drain, which was removed 2 days after insertion. The recurrent effusion that subsequently developed was also treated with percutaneous drainage.…”

Delayed pericardial effusions: life-threatening complication presenting up to 100 days after chest trauma

“…Delays of a few months have been described. [1][2][3][4][5] All, some or none of the classical features of a pericardial effusion may be present in these patients. 2 The cause of delayed effusions remains unclear.…”

“…2 Sealed-off lacerations have been found on surgical exploration while others report lacerated coronary arteries with thrombus in situ. 3,4 In children and infants blunt trauma to the chest or abdomen has resulted in unexplained haemopericardium. 6 In older patients, incidental anticoagulant use may contribute.…”