Yoon SY, Ye JB, Seok J. Undetected traumatic cardiac herniation like playing hide-and-seek-delayed incidental findings during surgical stabilization of flail chest: A case report. World J Clin Cases 2022; 10(36): 13396-13401 [PMID: 36683636 DOI: 10.12998/wjcc.v10.i36.13396]
Corresponding Author of This Article
Junepill Seok, MD, Assistant Professor, Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, No. 776 Sunhwan 1-Ro, Seowon-Gu, Cheongju 28644, South Korea. suc2601@cbnuh.or.kr
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2022; 10(36): 13396-13401 Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13396
Undetected traumatic cardiac herniation like playing hide-and-seek-delayed incidental findings during surgical stabilization of flail chest: A case report
Su Young Yoon, Jin-Bong Ye, Junepill Seok
Su Young Yoon, Junepill Seok, Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju 28644, South Korea
Jin-Bong Ye, Department of Trauma Surgery, Chungbuk National University Hospital, Cheongju 28644, South Korea
Author contributions: Seok J and Yoon SY wrote and revised the manuscript; Seok J, Yoon SY, and Ye JB contributed the patient care and management; Ye JB performed the initial emergency operation to rule out abdominal organ injuries; Seok J and Yoon SY performed thoracic surgery, including the pericardial repair and surgical rib fixations.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Junepill Seok, MD, Assistant Professor, Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, No. 776 Sunhwan 1-Ro, Seowon-Gu, Cheongju 28644, South Korea. suc2601@cbnuh.or.kr
Received: September 5, 2022 Peer-review started: September 5, 2022 First decision: November 11, 2022 Revised: November 16, 2022 Accepted: December 5, 2022 Article in press: December 5, 2022 Published online: December 26, 2022 Processing time: 108 Days and 14.1 Hours
Abstract
BACKGROUND
Post-traumatic blunt pericardial injury is a rare condition with only a few reported cases which were generally diagnosed during initial examinations upon admission. However, pericardial injuries not bad enough to dislocate the heart may only cause intermittent electrocardiogram (ECG) changes or be asymptomatic.
CASE SUMMARY
In this case, we report a blunt pericardial injury undetected on preoperative transthoracic echocardiography and chest computed tomography. We misjudged intermittent ECG changes and blood pressure fluctuations as minor symptoms resulting from cardiac contusion and did not provide intensive treatment. The pericardial injury was found incidentally during surgical stabilization of rib fractures and was successfully repaired.
CONCLUSION
Post-traumatic blunt pericardial ruptures should be considered in patients with blunt chest trauma showing abnormal vital signs and ECG changes.
Core Tip: Post-traumatic blunt pericardial rupture is a rare but fatal injury that is usually diagnosed with computed tomography upon admission, but the condition can be asymptomatic or misdiagnosed. If a patient with blunt chest trauma shows fluctuating vital signs and accompanying electrocardiogram abnormalities, pericardial rupture and cardiac herniation should be considered.
