Delayed cardiac tamponade following blunt chest trauma due to disruption of fourth costal cartilage with posterior dislocation

Abstract

Cardiac tamponade is a recognised sequelae of non-penetrating and penetrating chest trauma. Delayed cardiac tamponade has been described following blunt chest trauma. We present a 29 year-old gentleman who had initially presented to peripheral district general hospital following direct blunt chest wall trauma. His initial trauma CT demonstrated a small mediastinal haematoma and large left haemopneumothorax and disruption/dislocation of the costal cartilage. He initially underwent a thoracoscopic procedure uneventfully. He then had worsening chest radiograph appearances with enlarging cardiac contours. Transthoracic echocardiography confirmed cardiac tamponade. He underwent creation of a pericardial window and excision of the protruding fourth costal cartilage.

Keywords: Cardiac tamponade; Costal cartilage; Haemothorax; Pneumothorax; Thoracoscopy.

Fig. 1

Panel A - CT scan demonstrating, a. large left haemothorax (arrow), and b. left fourth rib fracture and disruption/dislocation of the costal cartilage medially (circled). Panels B and C - chest radiographs taken one week apart showing sizable increase in cardiac contours; A. on admission, B. one week post admission.

Fig. 2

Panel A - Repeat CT imaging which confirmed the presence of an enlarging pericardial effusion and bilateral pleural effusions. Panel B - MRI scan demonstrating the pericardial effusion.