Cardiac arrest following blunt trauma-induced tension viscerothorax mimicking tension pneumothorax: A rare case report

Abstract

Rationale: Tension viscerothorax is a severe condition characterized by significant increases in thoracic pressure due to the herniation of abdominal organs into the thoracic cavity. It is commonly observed in children with congenital diaphragmatic hernias or as a postoperative complication, while tension viscerothorax resulting from blunt trauma is rare.

Patient concerns: A 48-year-old male was urgently admitted to the emergency department with dyspnea following a fall from a height of 15 m.

Diagnoses: The patient, presenting in shock and based on clinical signs, was initially diagnosed with a tension pneumothorax (TPT). Bedside point-of-care ultrasound (POCUS) revealed substantial parenchymal echo abnormalities in the left thoracic cavity and cardiac displacement to the right, suggesting a left-sided tension viscerothorax. Thoracic and abdominal computed tomography confirmed the diagnosis of a rare left-sided tension viscerothorax.

Interventions: Due to the delayed diagnosis, the patient experienced a cardiac arrest. Following cardiopulmonary resuscitation and advanced life support, the patient regained spontaneous circulation and underwent an emergency laparotomy to reduce abdominal organs and repair a diaphragmatic hernia. Postoperatively, the patient received comprehensive medical care.

Outcomes: The patient recovered well postsurgery and was discharged after an 18-day hospital stay. Follow-up over 2 years revealed no significant complications.

Lessons: Blunt trauma-induced tension viscerothorax is rare and can easily be confused with TPT, leading to misdiagnosis. Early use of bedside POCUS is recommended for suspected cases to expedite identification and management, thereby improving survival rates.

Figure 1.

Patient’s chest and abdominal CT. (A) Stomach herniation into the left thoracic cavity. (B) Stomach and spleen above the diaphragm. (C) Left-sided tension viscerothorax with mediastinal and cardiac rightward shift. (D) Left-sided tension viscerothorax, mediastinal and cardiac rightward shift, left rib fractures, and significant left lung compression. CT = computed tomography.

Figure 2.

Postoperative chest and abdominal CT. (A, B) Small bilateral pleural effusion, left lower lung consolidation. (C) Postoperative stomach and spleen repositioned in the abdominal cavity, mediastinal and cardiac repositioning. CT = computed tomography.

Figure 3.

Follow-up imaging results. (A, B) Six months postoperatively, chest CT shows bilateral lungs essentially normal, with the liver, spleen, and stomach in their proper anatomical positions. (C) Two-year postoperative follow-up chest X-ray reveals no significant abnormalities. CT = computed tomography.