Imaging in blunt cardiac injury: Computed tomographic findings in cardiac contusion and associated injuries

Hammer, Mark M.; Raptis, Demetrios A.; Cummings, Kristopher W.; Mellnick, Vincent M.; Bhalla, Sanjeev; Schuerer, Douglas J.E.; Raptis, Constantine A.

doi:10.1016/j.injury.2015.11.008

Cited by 30 publications

(22 citation statements)

References 20 publications

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“…The most innocuous and most common of these injuries, cardiac contusion, is usually diagnosed based on troponin levels and ECG findings. Although CT can reveal multiple ancillary signs of cardiac contusion, myocardial enhancement is an insensitive indicator and should not be used to rule out cardiac injury [16]. Echocardiogram and occasionally MRI may aid diagnosis of cardiac contusion by evaluating for wall motion abnormalities.…”

Section: Cardiac Injurymentioning

confidence: 99%

Thoracic Trauma

Ketai

Primack

2019

IDKD Springer Series

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Section: Cardiac Injurymentioning

confidence: 99%

Thoracic Trauma

Ketai

Primack

2019

IDKD Springer Series

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“…The right ventricular wall is anatomically in close proximity to the dorsal sternum and represents the most vulnerable structure in cases of myocardial contusion. Compared to myocardial concussion, where only an abnormal myocardial wall motion with no anatomic or cellular injury is present, a myocardial contusion is associated with a manifest myocardial tissue damage 35. However, myocardial concussion should not be considered a benign entity, as it may cause severe rhythm disturbances.…”

Section: Trauma To the Heart And Great Vesselsmentioning

confidence: 99%

“…Autopsies of patients who died of BCT revealed myocardial contusion in up to 24% of the cases 27 36. Postmortem autopsy is the only way to retrospectively ensure the definite diagnosis of this category of BCT, whereas clinical diagnosis is often difficult and therefore the incidence is reported with wide discrepancy 35. Although myocardial damage can also result in ECG changes or myocardial enzyme release, such as troponin and CK-MB, these findings remain unspecific in most cases of BCT including myocardial contusion.…”

Section: Trauma To the Heart And Great Vesselsmentioning

confidence: 99%

“…Furthermore, Hammer et al analysed CT findings after myocardial contusions and reported on poor sensitivity of specific CT findings, such as myocardial hypoenhancement. Therefore, CT scan is not recommended as a reliable screening tool for detecting myocardial contusion 35. The pathomechanism of cardiac contusion is based on the myocardial damage at the cellular level.…”

Section: Trauma To the Heart And Great Vesselsmentioning

confidence: 99%

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Blunt chest trauma: a clinical chameleon

Eghbalzadeh

Sabashnikov

Zeriouh

et al. 2017

Heart

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The incidence of blunt chest trauma (BCT) is greater than 15% of all trauma admissions to the emergency departments worldwide and is the second leading cause of death after head injury in motor vehicle accidents. The mortality due to BCT is inhomogeneously described ranging from 9% to 60%. BCT is commonly caused by a sudden high-speed deceleration trauma to the anterior chest, leading to a compression of the thorax. All thoracic structures might be injured as a result of the trauma. Complex cardiac arrhythmia, heart murmurs, hypotension, angina-like chest pain, respiratory insufficiency or distention of the jugular veins may indicate potential cardiac injury. However, on admission to emergency departments symptoms might be missing or may not be clearly associated with the injury. Accurate diagnostics and early management in order to prevent serious complications and death are essential for patients suffering a BCT. Optimal initial diagnostics includes echocardiography or CT, Holter-monitor recordings, serial 12-lead electrocardiography and measurements of cardiac enzymes. Immediate diagnostics leading to the appropriate therapy is essential for saving a patient's life. The key aspect of the entire management, including diagnostics and treatment of patients with BCT, remains an interdisciplinary team involving cardiologists, cardiothoracic surgeons, imaging radiologists and trauma specialists working in tandem.

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“…Cardiac CT imaging has been used to assess myocardial contusion with regions of hypoenhancement (easier to visualise in the left ventricle than the right due to thicker walls) suggesting this diagnosis. 27 Cardiac MRI findings similar to myocardial infarction, including delayed gadolinium hyperenhancement and visualisation of necrotic tissue and myocardial oedema on T2 black blood imaging, have been reported in patients with cardiac contusion. [28][29][30] Regional wall motion abnormality involving anterior, anterolateral, anteroseptal left ventricular walls or septum, right ventricular wall oedema, pericardial effusion, tricuspid valve damage, and intramural haemorrhage have also been reported.…”

mentioning

confidence: 95%

An unusual cause of ventricular fibrillatory arrest

Kohli

Meinert

2020

Cardiol Young

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Myocarditis is an important cause of arrhythmogenic sudden cardiac arrest in the young. A strong index of suspicion is required as not only can arrhythmias be the only clinical manifestation but also because these patients can have normal cardiac biomarkers, electrocardiographic and echocardiographic findings, and inflammatory markers. Patients with ventricular arrhythmias in the setting of viral myocarditis, especially the ones in whom cardiac MRI findings normalise upon follow-up, tend to do well in the long run and an implantable cardioverter-defibrillator should be avoided in these patients; instead, a wearable defibrillator should be temporarily used as we did in this 7-year-old.

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Imaging in blunt cardiac injury: Computed tomographic findings in cardiac contusion and associated injuries

Cited by 30 publications

References 20 publications

Thoracic Trauma

Thoracic Trauma

Blunt chest trauma: a clinical chameleon

An unusual cause of ventricular fibrillatory arrest

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