Cardiac Injuries: A Review of Multidetector Computed Tomography Findings

Abstract

Trauma is the leading cause of death in United States in the younger population. Cardiac trauma is common following blunt chest injuries and is associated with high morbidity and mortality. This study discusses various multidetector computed tomography (MDCT) findings of cardiac trauma. Cardiac injuries are broadly categorized into the most commonly occurring blunt cardiac injury and the less commonly occurring penetrating injury. Signs and symptoms of cardiac injury can be masked by the associated injuries. Each imaging modality including chest radiographs, echocardiography, magnetic resonance imaging and MDCT has role in evaluating these patients. However, MDCT is noninvasive; universally available and has a high spatial, contrast, and temporal resolution. It is a one stop shop to diagnose and evaluate complications of cardiac injury. MDCT is an imaging modality of choice to evaluate patients with cardiac injuries especially the injuries capable of causing hemodynamic instability.

Keywords: Blunt Injuries; CT Scan, Spiral; Cardiac Rupture, Traumatic; Contusions; Hemopericardium.

Figure 1.. Contrast enhanced chest CT axial (A) and coronal (B) planes in a patient with penetrating injury. There is rupture of the lateral wall of the left ventricle (white arrow) with contrast extravasation causing tamponade (arrowhead). Left pleural effusion is also demonstrated (black arrow).

Figure 2.. Contrast enhanced CT chest in a patient who had a motor vehicle accident one week earlier. Original CT depicted sternal and rib fractures with no hemopericardium. Follow up contrast enhanced chest CT at the level of the aortic root (A) and interventricular septum (B) demonstrates a large delayed hemopericardium (white arrows). Sternal and rib fractures are also seen (black arrows).

Figure 3.. Contrast enhanced chest CT in a patient with blunt cardiac injury in the axial plane at the level of descending thoracic aorta; images (A) and (B) demonstrate rupture of the left lateral pericardium (white arrows) with altered axis of the heart. Bilateral small pleural effusions are also demonstrated (black arrows).

Figure 4.. Contrast enhanced CT chest axial plane at the level of descending thoracic aorta (A) in a patient with motor vehicle accident presenting with acute chest pain, elevated troponins and ST elevation shows LV aneurysm (black arrow). Catheter angiography (B) shows dissection/occlusion of the left anterior descending artery (white arrow).

Figure 5.. Contrast enhanced CT of the chest in axial (A) and saggital (B) planes in a patient with penetrating injury. There is rupture of the right ventricle (white arrow) with contained pseudoaneurysm and traumatic ventricular septal defect (black arrow).