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Case Reports
. 2010 Mar;18(1):28-30.
doi: 10.4250/jcu.2010.18.1.28. Epub 2010 Mar 31.

Delayed diagnosis of traumatic ventricular septal defect in penetrating chest injury: small evidence on echocardiography makes big difference

Kihyun Jeon  1 , Woo-Hyun Lim, Si-Hyuck Kang, Iksung Cho, Kyung-Hee Kim, Hyung-Kwan Kim, Yong-Jin Kim, Dae-Won Sohn
Affiliations
Case Reports

Delayed diagnosis of traumatic ventricular septal defect in penetrating chest injury: small evidence on echocardiography makes big difference

Kihyun Jeon et al. J Cardiovasc Ultrasound. 2010 Mar.

Abstract

Cardiac trauma from penetrating chest injury is a life-threatening condition. It was reported that < 10% of patients arrives at the emergency department alive. Penetrating chest injury can cause serious damage in more than 1 cardiac structure, including myocardial lacerations, ventricular septal defect (VSD), fistula between aorta and right cardiac chamber and valves. The presence of pericardial effusion (even a small amount) on the initial echocardiography might be the only clue to serious cardiac damage in the absence of definite evidence of anatomical defect in heart. We here present a case, in which clear diagnosis of VSD and pseudoaneurysmal formation was delayed a few days after penetrating chest injury due to the lack of anatomical evidence of damage.

Keywords: Penetrating chest trauma; Ventricular septal defect.

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Figures

Fig. 1
Fig. 1
Initial CT angiography reveals a small extent of low attenuation lesion at the mid anteroseptal myocardium (arrow).
Fig. 2
Fig. 2
Follow up CT angiography performed at 3 days after injury. Short axis plane (A) and coronal plane (B) shows traumatic ventricular septal defect (VSD) at left ventricular mid-anteroseptal wall (arrow). LV: left ventricle, RV: right ventricle.
Fig. 3
Fig. 3
Follow up echocardiography showing traumatic ventricular septal defect (VSD). Parasternal short axis view (A) shows the VSD at the basal to mid junction of anteroseptum (arrow) and a Doppler image (B) reveals mitral flow variation according to respiratory cycle, suggestive of constrictive physiology. LV: left ventricle, RV: right ventricle.
Fig. 4
Fig. 4
Cardiac magnetic resonance image for preoperative evaluation. Cardiac MRI shows traumatic ventricular septal defect (VSD) in the mid-anterior septal wall (arrow).
See this image and copyright information in PMC

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