Delayed Tamponade after Traumatic Wound with Left Ventricular Compression

Abstract

Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management.

Late Cardiac Tamponade in a Patient Victim of Penetrating Trauma – Case Report

“…Cardiac tamponade is often associated with stab injury, clinically evidenced by the Beck’s triad, which is present in a minority of patients (low blood pressure, muffled heart sounds and increased jugular venous pressure) [ 3 , 4 ] . In the present case, despite the last two criteria present, the patient's blood pressure was slightly elevated.…”

“…Because available diagnostic methods and initial management when cardiac trauma are suspected, late cardiac tamponade is rare and may occur up to 100 days after trauma and can have an atypical presentation. The etiology of delayed cardiac tamponade is unclear, although some mechanisms have been proposed to explain, including clot sealing a partial tear that allows a leak into the pericardial sac [ 3 ] .…”

Traumatic retrosternal hematoma leading to extra-pericardial cardiac tamponade—Case report

“…Cardiac tamponade is a well-known condition associated with fluid or gas collection in the pericardial space. Mediastinal hematoma leading to cardiac tamponade had been described in various clinical conditions including cardiac tamponade post-open heart surgery [5], following cardiac and mediastinal penetration [6], and anterior mediastinal hematoma caused by blunt trauma [7,8].…”

Delayed Pericardial Tamponade after Nail Gun Injury to the Right Ventricle

“…The tip of the nail hit the right ventricle during cardiac movement causing a small puncture followed by gradual bleeding and formation of intra-pericardial hematoma. Delayed pericardial tamponade after penetrating cardiac injury is a challenging diagnostic and therapeutic entity, with several proposed mechanisms including clot sealing a partial tear associated with slow leak into pericardium or sudden dislodgment followed by rapid accumulation of blood [18]. In stable patients and in those with unclear presentation, imaging modalities particularly echocardiography have a vital role to confirm the presence of pericardial tamponade [13].…”

“…A controversy remains regarding the conservative management and pericardiocentesis in patients with no tamponade and stable hemodynamic status. Percardiocentesis can serve as a temporary life-saving measure, particularly as a bridge to definitive therapy [18,19]. The presence of pericardial tamponade indicates an emergent surgical intervention via median sternotomy or thoracotomy according to the location of cardiac injury [20].…”