Imaging Patients with Cardiac Trauma

Abstract

In the United States, trauma is the leading cause of death among those who are 1-44 years old, with cardiovascular injuries representing the second most common cause of traumatic death after central nervous system injuries. Evaluation of trauma patients with suspected cardiac injury may be complex and include electrocardiography, measurement of cardiac biomarkers, and imaging examinations. Contrast material-enhanced computed tomography (CT) has become one of the most valuable imaging tools available for evaluating hemodynamically stable patients with suspected cardiac injury. The presence of hemopericardium, with or without cardiac tamponade, is one of the most significant findings of cardiac injury. Other complications that result from blunt cardiac injury, such as pericardial rupture and cardiac herniation, may be readily depicted at multidetector CT. Assessment of patients with cardiac injuries, particularly those with penetrating injuries, is a challenging and time-critical matter, with clinical and imaging findings having complementary roles in the formation of an accurate diagnosis. Patients who are hemodynamically stable, particularly those with penetrating cardiac injuries, also may benefit from a timely imaging examination. In addition to chest radiography, other available modalities such as transthoracic and transesophageal echocardiography, nuclear medicine, and magnetic resonance imaging may play a role in selected cases.

Possibilities of videothoracoscopy for penetrating thoracic injuries

“…5, при стабильной ге-модинамике имеется достаточно времени для пол-ноценного дооперационного обследования. В слу-чае если рутинное ультразвуковое исследование не свидетельствует о наличии гемоперикарда и необхо-димости торакотомии, то целесообразно выполнить комплекс дополнительных обследований [8,21,23,25], поскольку выявить до операции гемоперикард малого объема традиционными методами удавалось редко. Если при эхокардиографии или компьютер-ной томографии в полости перикарда выявляют ми-нимальное количество жидкости, то для исключе- ния гемоперикарда целесообразно выполнение ВТС и перикардиотомии [5].…”

Imaging of Thoracic Trauma

“…The tear is typically a longitudinal one located along the pericardiophrenic nerve and occurs more commonly on the left side. The mortality of patients with cardiac herniation is high, with death resulting from torsion along the inferior vena cava and great vessels and cardiac strangulation [8].…”

“…It is most commonly associated with injury to the aortic root and ascending aorta but may also result from cardiac chamber rupture, myocardial contusion, and coronary artery laceration [8]. Simple fluid should demonstrate attenuation values of 0-10 Hounsfield units (HU) whereas hemopericardium will have attenuation values in the 35-HU range.…”

“…The rapid accumulation of hemopericardium may result in cardiac tamponade. The latter diagnosis in patients with blunt chest trauma is suggested when CT demonstrates a triad of high-attenuation pericardial effusion, distention of the inferior vena cava and renal veins, and periportal low-attenuation fluid [8].…”

Bildgebung des stumpfen Thoraxtraumas

“…Verletzungen des Herzens im Rahmen eines stumpfen Thoraxtraumas sind durch eine hohe Letalität gekennzeichnet [35]. Das Spektrum der möglichen Verletzungen reicht dabei von einer fokalen Kontusion bis hin zur Herzruptur [24].…”