Pectus Excavatum in Blunt Chest Trauma

A Case Report

Emmanouil Liodakis; Eirini Liodaki; Hrayr G Basmajian; Nael Hawi; Maximilian Petri; Christian Krettek; Michael Jagodzinski

Disclosures

J Med Case Reports. 2013;7(22) 

In This Article

Abstract and Introduction

Abstract

Introduction: Blunt cardiac rupture is an exceedingly rare injury.

Case presentation: We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found.

Conclusion: Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

Introduction

Blunt cardiac rupture is an exceedingly rare injury. Patients with cardiac rupture following blunt thoracic trauma rarely survive and most die at the scene of the accident or soon after in the emergency room, before the cardiac lesions are detected.[1,2] Cardiac squeezing between the sternum and spine is postulated as the most likely trauma mechanism.[3,4]

Pectus excavatum accounts for 90% of congenital chest wall deformities and refers to the posterior depression of the sternum and adjacent costal cartilages. Pectus excavatum is more than a cosmetic deformity because it can cause cardiopulmonary impairment and physiologic limitations. The depressed sternum often compresses the right atrium as well as the right ventricle.[5] Rationally, the incidence of cardiac ruptures should be higher in patients with pectus excavatum.

We report a case of a woman who survived rupture of the left ventricle following blunt chest trauma after presenting hemodynamically stable and without signs of pericardial tamponade.

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