Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

Abstract

Blunt trauma may cause cardiac perforation requiring emergency surgical repair. Cardiac perforations are usually diagnosed by the presence of a pericardial effusion on echocardiography. However, cardiac perforations and pericardial effusions are sometimes too small to detect, resulting in underdiagnosis. In this case report, we describe a 22-year-old man who was involved in a traffic accident, admitted in a state of shock, and was initially treated for tension pneumothorax and liver and spleen injuries. His initial computed tomography scans revealed a small region of enhancement, corresponding to a small pericardial effusion, indicative of a cardiac perforation. Thus, an emergency median sternotomy was performed. He was diagnosed with perforation of the left atrial ear and right atrium, which were repaired surgically. His liver and spleen injuries were also treated, and the patient was discharged 44 days after admission. The detection of a small pericardial effusion on enhanced computed tomography enabled rapid diagnosis of a cardiac perforation and ensured emergency surgical repair could be performed as soon as possible.

Learning objectives: •To acknowledge the difficulty of diagnosing cardiac perforation in patients with pericardial injury, based on conventional signs of blunt cardiac injury, such as sternal fracture, serum cardiac enzymes, and hemothorax.•To recognize that a small pericardial effusion on enhanced computed tomography scans is an important finding that should raise suspicion of cardiac perforation and pericardial injury.

Keywords: Blunt trauma; Cardiac perforation; Computed tomography; Echography; Pericardial effusion; Troponin.

Fig. 1

Initial chest X-ray showing left tension pneumothorax. No clear evidence of hemothorax is visible.

Fig. 2

Enhanced abdominal computed tomography showing abdominal bleeding and left and right liver lobe injuries.

Fig. 3

(a) Early-phase enhanced chest computed tomography showing a small pericardial effusion and left hemothorax. (b) Late-phase enhanced chest computed tomography showing an enhanced pericardial effusion compared with the early phase (arrows).

Fig. 4

Operative findings of cardiac surgery. The left atrial ear was repaired with proline sutures (arrows).