scholarly journals Penetrating cardiac stab wounds: A case report with management algorithm and review of the literature

2018 ◽  
Vol 14 (2) ◽  
Author(s):  
Antonino M. Grande ◽  
Filippo Antonacci ◽  
Paolo Aseni
Keyword(s):  
Cardiac Injury ◽  
Penetrating Trauma ◽  
Pericardial Fluid ◽  
Stab Wounds ◽  
Emergency Department Thoracotomy ◽  
Management Algorithm ◽  
Left Pleural Effusion ◽  
Immediate Surgery ◽  
The Right ◽  
Midline Sternotomy

A 57-year-old man attempted a suicide self-inflicting multiple scissors stab wounds in the chest. At the scene, Focused Assessment with Sonography in Trauma (FAST) showed an important left pleural effusion and pericardial fluid. Computed Tomography Angiography confirmed the pericardial effusion. The patient underwent immediate surgery. Three epicardial wounds of the anterior surface of the right ventricle were identified, one of which was actively bleeding. The lesion was sutured, the patient recovered uneventfully, and on the sixth postoperative day was transferred to a psychiatric unit. At 6-month follow-up, he is doing well and has returned to work. We discuss the importance of FAST for an early diagnosis of chest penetrating trauma leading to a rapid life-saving cardiac procedure and propose a clinical-based protocol for the management of patients with suspected penetrating cardiac injury which we have applied in our service for last six years. Midline sternotomy should be considered the incision of choice in patients with penetrating trauma in the cardiac box with evidence of injury to the heart and great vessels. Emergency Department Thoracotomy can be a possible option for those patients with impending cardiac arrest despite adequate resuscitation.

Delayed presentation of cardiac injury four weeks after stabbing

2019 ◽  
Vol 28 (1) ◽  
pp. 62-64
Author(s):  
Ayame Ochi ◽  
Ashutosh A Hardikar
Keyword(s):  
Coronary Artery ◽  
Right Ventricle ◽  
Cardiac Tamponade ◽  
Cardiac Injury ◽  
Penetrating Trauma ◽  
Delayed Presentation ◽  
Stab Injury ◽  
Artery Injury ◽  
Coronary Artery Injury ◽  
The Right

Penetrating trauma to the heart has a high associated mortality due to significant hemorrhage, coronary artery injury, and cardiac tamponade. Such sequelae progress rapidly, often leading to death before reaching hospital. We report a case of delayed presentation following a stab injury to the right ventricle. This case highlights the mechanisms that may facilitate a delayed presentation and the importance of appropriate investigation when suspicion of cardiac injury is high.

scholarly journals Missed Traumatic Conoventricular Septal Defect: A Case Report

2021 ◽  
Vol 24 (4) ◽  
pp. E680-E683
Author(s):  
Mingjin Cheng ◽  
Niuliu Huang ◽  
Chengdong Ning ◽  
Qianlun Huo
Keyword(s):  
Septal Defect ◽  
Cardiac Injury ◽  
Penetrating Trauma ◽  
Emergency Operation ◽  
Ventricular Septum ◽  
Right Ventricular Free Wall ◽  
Left Chest ◽  
Septal Defects ◽  
The Right ◽  
Penetrating Cardiac Injury

Traumatic ventricular septal defects (VSDs) after penetrating trauma to the left chest are rare. Most of the traumatic VSDs are located in the muscular ventricular septum, and a few reports place them in the membranous ventricular septum. There has been no report of traumatic conoventricular VSD by penetrating trauma. We present a case of penetrating cardiac injury (PCI). The rupture of the right ventricular free wall was found and repaired in emergency operation. This is the first report of the use of auricular forceps to control cardiac rupture bleeding. After operation, we found traumatic conoventricular VSD, which was repaired under cardiopulmonary bypass.

scholarly journals Diagnostic pitfalls: intramyocardial lymphoma metastasis mimics acute coronary syndrome in a diffuse large B cell lymphoma patient—case report

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Lilla Prenek ◽  
Klára Csupor ◽  
Péter Beszterczán ◽  
Krisztina Boros ◽  
Erika Kardos ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Pericardial Fluid ◽  
Cardiac Tumors ◽  
Lymphoma Patient ◽  
Coronary Syndrome ◽  
Large B Cell Lymphoma ◽  
The Right ◽  
Large B Cell

Abstract Background Cardiac tumors are very uncommon compared to other cardiac diseases. Their clinical symptoms can vary from absent to non-specific. The most common symptoms are arrhythmias, blood flow obstruction due to valvular dysfunction, shortness of breath, systemic embolization, and accumulation of pericardial fluid. Hereby, we describe a very rare case of a diffuse large B cell lymphoma patient who presented with the symptoms and signs of acute coronary syndrome (ACS) but the patient’s complaints were caused by his intramyocardial lymphoma metastasis. Case presentation Forty-eight-year-old diffuse large B cell lymphoma patient was admitted to our emergency department with chest pain, effort dyspnea, and fever. The patient had normal blood pressure, blood oxygen saturation, sinus tachycardia, fever, crackles over the left lower lobe, novum incomplete right bundle branch block with Q waves and minor ST alterations, elevated C-reactive protein, high-sensitivity troponin-T, and d-dimer levels. Chest X-ray revealed consolidation on the left side and enlarged heart. Bed side transthoracic echocardiography showed inferior akinesis with pericardial fluid. Coronary angiography showed no occlusion or significant stenosis. Chest computed tomography demonstrated the progression of his lymphoma in the myocardium. He was admitted to the Department of Hematology for immediate chemotherapy and he reached complete metabolic remission, followed by allogeneic hematopoietic stem cell transplantation. Unfortunately, about 9 months later, he developed bone marrow deficiency consequently severe sepsis, septic shock, and multiple organ failure what he did not survive. Conclusions Our case demonstrates a very rare manifestation of a heart metastasis. ACS is an unusual symptom of cardiac tumors. But our patient’s intramyocardial lymphoma in the right atrium and ventricle externally compressed the right coronary artery and damaged the heart tissue, causing the patient’s symptoms which imitated ACS. Fortunately, the quick diagnostics and immediate aggressive chemotherapy provided the patient’s remission and suitability to further treatment.

CT-Guided Pericardiocentesis

1996 ◽  
Vol 37 (3P2) ◽  
pp. 775-778 ◽  
Author(s):  
O. Duvernoy ◽  
A. Magnusson
Keyword(s):  
Cardiac Surgery ◽  
Pericardial Effusion ◽  
Guide Wire ◽  
Pericardial Fluid ◽  
Good Information ◽  
Indwelling Catheter ◽  
Ct Guided ◽  
Cardiac Apex ◽  
The Right ◽  
Stereotactic Device

Purpose: Pericardial effusion in patients who have recently undergone cardiac surgery is often trapped in compartments. CT of the pericardium provides good information about the distribution of pericardial fluid in the postoperative period after cardiac surgery. Contrary to echocardiography, CT imaging is not affected by postoperative mediastinal emphysema and pain from the wound. A method for CT-guided pericardiocentesis was developed. Material and Methods: CT-guided pericardiocentesis was carried out with a stereotactic device in 10 patients. The pericardium was punctured with a 0.9-mm needle and a 0.46-mm guide wire was introduced through the needle. An indwelling catheter was introduced over the guide wire and was left in the pericardium. Both the subxiphoid and parasternal approaches were used. Results: CT guidance facilitated placement of an indwelling catheter into the pericardial space in positions difficult to reach in patients with postoperative pericardial compartments, i.e. near the right atrium and adjacent to the cardiac apex/left ventricle. Conclusion: CT-guided pericardiocentesis offers a new possibility in patients where fluoroscopically or echocardiographically guided pericardiocentesis is difficult.

scholarly journals Anterior Spinal Cord Syndrome is a Complication Following Embolisation of Bleeding Intercostal Artery in Penetrating Trauma: A Case Report

2020 ◽  
Author(s):  
Tovi Vo ◽  
Daniel Harris ◽  
Ngee Foo ◽  
Daniel Eillis
Keyword(s):  
Spinal Cord ◽  
Trauma Patient ◽  
Penetrating Trauma ◽  
Intercostal Artery ◽  
Spinal Cord Infarction ◽  
Contrast Extravasation ◽  
Transcatheter Arterial Embolisation ◽  
Arterial Embolisation ◽  
Artery Of Adamkiewicz ◽  
The Right

Abstract Background:Transcatheter arterial embolisation of intercostal vessels is a minimally invasive procedure that is increasingly being used in the management of haemothorax in the trauma patient, however significant complications – such as spinal ischaemia can occur. We present a rare case of paralysis in a patient following embolisation of the intercostal arteries due to bleeding from penetrating trauma.Case presentation:A 46-year-old male presented to the Emergency department with two stab wounds to the right posterior chest. Computed tomography scan of the chest revealed active contrast extravasation from the right 9th intercostal artery. Selective embolisation of the right 9th intercostal artery using Gelfoam® and coils as well as further embolisation of the 7th, 8th and 10th intercostal arteries was performed. Unfortunately due to ongoing bleeding and hypotension, the patient subsequently required emergency surgery that revealed two penetrating injuries to the right inferior lobe of the lung. After the patient was extubated, he was found to have bilateral motor from the level of L4 and below and sensory deficits from L2 and below. Magnetic resonance imaging of the spine showed spinal cord infarction at the level of T11 and T12 that was thought to be secondary to the embolisation of the intercostal arteries inadvertently affecting the artery of Adamkiewicz.Conclusions:Transcatheter arterial embolisation has an established roll in haemostasis of the trauma patient – particularly in intercostal arteries for the management of haemothorax. Although extremely rare, spinal complications from this procedure can be significantly life changing for the patient. The variable anatomy of the artery of Adamkiewicz should be carefully considered on a case-by-base basis in the stable trauma patient and balance of risk versus benefit be determined if the artery is unable to be identified on pre-procedure angiography.

Direct traumatic optic neuropathy in a temporal laceration: A case report

Trauma ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 66-68
Author(s):  
Simon WJ Grant ◽  
Moorthy Halsnad ◽  
Steve Colley ◽  
Ian Sharp
Keyword(s):  
Optic Neuropathy ◽  
Penetrating Trauma ◽  
Temporal Region ◽  
Computerised Tomography ◽  
Traumatic Optic Neuropathy ◽  
Maxillofacial Region ◽  
Case Presentation ◽  
Orbital Wall ◽  
The Right ◽  
Tomography Scan

Facial lacerations are a common presentation in emergency departments. It is important to appreciate the mechanism of injury and the anatomy of structures involved in penetrating lacerations in the maxillofacial region. A 65-year-old man suffered an accidental penetrating injury with a sharp kitchen knife to the right temporal region. There was a single laceration to the right temporal region. The right eye had no perception to light, a total afferent and efferent pupillary defect and partial ophthalmoplegia. Computerised tomography scan revealed signs of penetration through the skin, temporalis, postero-lateral orbital wall and orbital apex. There was no injury to the globe or either retrobulbar or intracranial haemorrhage. A diagnosis of direct traumatic optic neuropathy was made following consultation with opthalmology and neurosurgery teams. Only two similar cases of penetrating trauma in the temporal region resulting in direct traumatic optic neuropathy have been identified in the literature. This case presentation highlights the structures that are at risk of damage from penetrating trauma in the maxillofacial region.

scholarly journals Cardiac tamponade secondary to hemorrhagic pericardial effiision in five dogs

2017 ◽  
Vol 56 (1) ◽  
pp. 9
Author(s):  
C. G. HATZIGIANNAKIS (Χ.Γ. ΧΑΤΖΗΓΙΑΝΝΑΚΗΣ) ◽  
M. E. MYLONAKIS (Μ. Ε. ΜΥΛΩΝΑΚΗΣ) ◽  
M. N. SARIDOMICHELAKIS (Μ.Ν. ΣΑΡΙΔΟΜΙΧΕΛΑΚΗΣ) ◽  
M. PATSIKAS (Μ. ΠΑΤΣΙΚΑΣ) ◽  
D. PSALLA (Δ. ΨΑΛΛΑ) ◽  
...  
Keyword(s):  
Ultrasound Examination ◽  
Histopathological Examination ◽  
Clinical Findings ◽  
Pericardial Fluid ◽  
Exercise Intolerance ◽  
Right Atrial ◽  
Atrial Wall ◽  
History Of ◽  
Cardiac Silhouette ◽  
The Right

A 7-year old female collie (case 1), a 3-year old male Caucasian-cross (case 2) and three male German shepherds with an age of 11 (case 3), 8.5 (case 4) and 10 (case 5) years, respectively, were admitted with a history of decreased appetite, depression, exercise intolerance, dyspnea and progressive abdominal enlargement, for the last 10 to 60 days. Poor body condition (5/5), muffled heart sounds (5/5), weak femoral pulse (5/5), ascites (5/5), inspiratory or inspiratory-expiratory dyspnea (5/5), pulsus paradoxus (2/5) and jugular vein distension (2/5) were the prominent clinical findings, while mature neutrophilic leukocytosis (3/5), lymphopenia (3/5), eosinopenia (3/5), hypoproteinemia (5/5) and increased urea nitrogen (3/5) were the most prevalent clinicopathologic abnormalities. Apart from a space-occupying lesion onto the right atrial wall of one dog (case 4), radiographic and ultrasound examination showed a globe-shaped cardiac silhouette (5/5), pericardial effusion (5/5), ascites (5/5) and pleural effusion (4/5). A large amount of non-clotting hemorrhagic effusion was drained during pericardiocentesis, resulting in rapid clinical recovery. Physical, chemical and cytological evaluation of the pericardial fluid was non-contributory in the differentiation between neoplastic and non-neoplastic causes of these effusions. Case 3 died 25 days post-pericardiocentesis; right atrium hemangiosarcoma and pulmonary metastases were documented on post mortem histopathological examination. Another dog (case 5) died of unknown causes one month after pericardiocentensis. On the contrary, dogs 1, 2 and 4 were still clinically healthy for a followup period of 16, 2 and 8 months, respectively.

Case Report: Penetrating Cardiac Injury Secondary to a Terrorism-Related Nail Bomb Explosion

2003 ◽  
Vol 18 (3) ◽  
pp. 249-252 ◽  
Author(s):  
Yasufumi Asai ◽  
Masashi Yoshida ◽  
Yoshihiko Kurimoto ◽  
Jeffrey L. Arnold
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Unusual Case ◽  
Surgical Intervention ◽  
Cardiac Injury ◽  
Pericardial Tamponade ◽  
Stab Wounds ◽  
Penetrating Cardiac Injury ◽  
Bomb Explosion ◽  
Prompt Diagnosis

AbstractPenetrating cardiac injuries commonly occur secondary to gunshot or stab wounds. This is a report an unusual case of a patient who sustained a penetrating cardiac injury due to a nail from a terrorism-related, nail-bomb explosion. Associated problems included pericardial tamponade, penetrating cardiac injuries, acute, traumatic, myocardial infarction, and a penetrating lung injury. Prompt diagnosis and aggressive surgical intervention resulted in full recovery of the patient.

Predictors for Survival of Penetrating Trauma Using Emergency Department Thoracotomy in an Urban Trauma Center: The Cardiac Instability Score

2010 ◽  
Vol 102 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Suryanarayana Siram ◽  
Tolulope Oyetunji ◽  
Shaneeta M. Johnson ◽  
Amal L. Khoury ◽  
Patricia M. White ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Center ◽  
Penetrating Trauma ◽  
Emergency Department Thoracotomy
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