An Evaluation of Blunt Traumatic Pericardial Rupture

• Published in: Nihon Kyukyu Igakukai Zasshi 1992/08/15, Vol.3(4), pp.163-172
• Main Authors: Kato, Kazuyoshi, Henmi, Hiroshi, Yamamoto, Yasuhiro, Mashiko, Kunihiro, Kimura, Akio, Kushimoto, Shigeki, Otsuka, Toshifumi
• Format: Article
• Language: English
• Subjects: blunt trauma; cardiac injury; pericardial rupture; shearing force; thoracic injury
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.3.163

Purpose, materials and methods: We have experienced twenty-four patients with blunt traumatic pericardial rupture in our department during a period of sixteen years and nine months. To clarify the characteristics of the injury, we performed a retrospective evaluation of these patients. The factors analyzed were mechanism of injury, strength and direction of the force that caused the injury, condition of each patient upon admission, injured site, associated injury, Injury Severity Score (ISS), methods of diagnosis and treatment, outcome and overall mortality. Results: Blunt traumatic pericardial rupture occured in severely traumatized patients, i.e., victims of traffic accidents or falls. The patients suffering such injuries received considerable force to the thorax in their accidents. Among patients who fell, more than 2×1010erg of energy was estimated to have been consumed in a very short time when a pericardial injury was sustained. The direction of force was oblique rather than exactly left or right, front or back to the body of the victim. Of the patients who came to our department, 42% came with no vital signs and 42% came with shock. Thirteen cases (54%) incurred injury to the left side of the pericardium. Thirteen cases had combined cardiac injury. There were two cases presented with no left thoracic injury except for pericardial injury. The median ISS was 41. The injury was generally diagnosed in a thoracotomy or on plain chest X-ray film. The mortality of the patients who came with vital signs was 57%. Discussion: The force capable of causing blunt traumatic pericardial rupture is very large. A crushing force or a shearing force to the thoracic cage seems to contribute to this injury. The injury is often seen on the left side of the pericardium, but it can be on the right side, mediastinal part, or pleuropericardial part. No specific relationships were demonstrated between the injured site and the direction or strength of the force causing the injury. Conclusion: This injury is usually seen as part of a very severe injury which is often fatal. However, over 40% of the patients with this injury who come with vital signs can be saved. Therefore, early diagnosis is essential. Treatment should be undertaken immediately to prevent cardiac luxation or intrapericardial herniation of the abdominal viscera.