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Successful diagnosis of pericardial rupture caused by blunt chest trauma using contrast ultrasonography

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Abstract

A 65-year-old male developed acute myocardial infarction due to coronary artery dissection and tricuspid valve injury after blunt chest trauma. Acute myocardial infarction was treated by coronary artery intervention; however, refractory heart failure with pleural effusion remained. The first transthoracic echocardiography (TTE) on admission failed to clearly visualize the tricuspid valve and right ventricle due to poor image quality. A follow-up TTE with contrast ultrasonography revealed pericardial rupture in addition to tricuspid regurgitation. Ruptures of the tricuspid papillary muscle and pericardium were confirmed during surgery and were repaired successfully. Blunt chest trauma results in various cardiac injuries including cardiac rupture, intramural hematoma, valvular injury, coronary artery injury, and electrical disturbances, leading to critical conditions and high mortality. Of such blunt trauma-induced injuries, coronary artery dissection, tricuspid valve injury, and pericardial rupture caused by blunt chest trauma are rare, and simultaneous occurrence of the three types of injuries that were successfully repaired has not been reported. In addition, this case indicates the utility of contrast ultrasonography for diagnosis of pericardial rupture caused by blunt chest trauma.

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Acknowledgments

We are grateful to Yasuko Miyaki, M.D., Ph.D. and Nobuyuki Takagi M.D., Ph.D. for their assistance in surgical repair. We are also grateful to Akiyoshi Hashimoto M.D., Ph.D. for giving many useful discussions.

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Authors and Affiliations

  1. Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-0061, Japan

    Yuki Tatekoshi, Satoshi Yuda, Makoto Ogasawara, Atsuko Muranaka, Nobuaki Kokubu & Tetsuji Miura

  2. Department of Infection Control and Clinical Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

    Satoshi Yuda

  3. Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

    Mamoru Hase

  4. Division of Health Care Administration and Management, Sapporo Medical University School of Medicine, Sapporo, Japan

    Kazufumi Tsuchihashi

  5. Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan

    Kazutoshi Tachibana & Tetsuya Higami

Authors
  1. Yuki Tatekoshi
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  2. Satoshi Yuda
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  3. Makoto Ogasawara
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  4. Atsuko Muranaka
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  5. Nobuaki Kokubu
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  6. Mamoru Hase
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  7. Kazutoshi Tachibana
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  8. Kazufumi Tsuchihashi
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  9. Tetsuya Higami
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  10. Tetsuji Miura
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Corresponding author

Correspondence to Yuki Tatekoshi.

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Ethical considerations

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

Conflict of interest

Yuki Tatekoshi, Satoshi Yuda, Makoto Ogasawara, Atsuko Muranaka, Nobuyuki Kokubu, Kazutoshi Tachibana, Mamoru Hase, Kazufumi Tsuchihashi, and Tetsuji Miura declare that they have no conflict of interest.

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Tatekoshi, Y., Yuda, S., Ogasawara, M. et al. Successful diagnosis of pericardial rupture caused by blunt chest trauma using contrast ultrasonography. J Med Ultrasonics 43, 95–98 (2016). https://doi.org/10.1007/s10396-015-0663-z

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  • DOI: https://doi.org/10.1007/s10396-015-0663-z

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