CT Imaging of Cardiac Trauma

  • Demetrios A. RaptisEmail author
  • Sanjeev Bhalla
  • Constantine A. Raptis
Emergency Radiology (J Yu, Section Editor)
Part of the following topical collections:
  1. Emergency Radiology


Cardiac injury can occur in the setting of blunt and penetrating trauma resulting in significantly adverse clinical outcomes. While the clinical presentation is variable and computed tomographic (CT) imaging is rarely performed to specifically evaluate for cardiac injury, the ability to recognize the findings of cardiac injury on CT examinations performed for thoracic trauma is essential to avoid misdiagnosis and direct potentially life-saving intervention. This article reviews the direct and indirect CT findings of cardiac injury.


Cardiac trauma Blunt cardiac injury Penetrating cardiac injury Myocardial contusion Myocardial rupture 


Compliance with Ethical Guidelines

Conflict of interest

Demetrios A. Raptis, Sanjeev Bhalla, and Constantine A. Raptis each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Parmley LF, Manion WC, Mattingly TW. Nonpenetrating traumatic injury of the heart. Circulation. 1958;18(3):371–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Sigler LH. Traumatic injury of the heart; incidence of its occurrence in 42 cases of severe accidental bodily injury. Am Heart J. 1945;30:459–78.CrossRefPubMedGoogle Scholar
  3. 3.
    Feghali NT, Prisant LM. Blunt myocardial injury. Chest. 1995;108(6):1673–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Symbas PN. Cardiothoracic trauma. Curr Probl Surg. 1991;28(11):741–97.CrossRefPubMedGoogle Scholar
  5. 5.
    Schultz JM, Trunkey DD. Blunt cardiac injury. Crit Care Clin. 2004;20(1):57–70.CrossRefPubMedGoogle Scholar
  6. 6.
    •• Bellister SA, Dennis BM, Guillamondegui OD. Blunt and penetrating cardiac trauma. Surg Clin North Am. 2017;97(5):1065–76. Very important article discussing the incidence, evaluation, diagnosis, and treatment of patients with suspected blunt or penetrating cardiac injury.
  7. 7.
    Emet M, Akoz A, Aslan S, Saritas A, Cakir Z, Acemoglu H. Assessment of cardiac injury in patients with blunt chest trauma. Eur J Trauma Emerg Surg. 2010;36(5):441–7. Scholar
  8. 8.
    Mirvis SE. Imaging of acute thoracic injury: the advent of MDCT screening. Semin Ultrasound CT MR. 2005;26(5):305–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Co SJ, Yong-Hing CJ, Galea-Soler S, et al. Role of imaging in penetrating and blunt traumatic injury to the heart. Radiographics. 2011;31(4):E101–15. Scholar
  10. 10.
    Restrepo CS, Gutierrez FR, Marmol-Velez JA, Ocazionez D, Martinez-Jimenez S. Imaging patients with cardiac trauma. Radiographics. 2012;32(3):633–49. Scholar
  11. 11.
    Wisner DH, Reed WH, Riddick RS. Suspected myocardial contusion. Triage and indications for monitoring. Ann Surg. 1990;212(1):82–6.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    • Hammer MM, Raptis DA, Cummings KW, et al. Imaging in blunt cardiac injury: computed tomographic findings in cardiac contusion and associated injuries. Injury. 2016;47(5):1025–30. Important reference as it discusses the clinical usefulness and associated injury findings seen in patients with direct and indirect CT findings of cardiac injury.
  13. 13.
    Galindo Gallego M, Lopez-Cambra MJ, Fernandez-Acenero MJ, et al. Traumatic rupture of the pericardium. Case report and literature review. J Cardiovasc Surg (Torino). 1996;37(2):187–91.Google Scholar
  14. 14.
    Kan C-D, Yang Y-J. Traumatic aortic and mitral valve injury following blunt chest injury with a variable clinical course. Heart Br Card Soc. 2005;91(5):568–70. Scholar
  15. 15.
    Saric P, Ravaee BD, Patel TR, Hoit BD. Acute severe mitral regurgitation after blunt chest trauma. Echocardiography. 2018;35(2):272–4. Scholar
  16. 16.
    van Son JA, Danielson GK, Schaff HV, Miller FA. Traumatic tricuspid valve insufficiency. Experience in thirteen patients. J Thorac Cardiovasc Surg. 1994;108(5):893–8.PubMedGoogle Scholar
  17. 17.
    Murakami S, Suwa M, Morita H, et al. Images in cardiovascular medicine. Localized pulmonary edema after blunt chest trauma. Circulation. 2007;115(8):e206–7. Scholar
  18. 18.
    Asensio JA, Garcia-Nunez LM, Petrone P. Trauma to the heart. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 6th ed. New York: McGraw Hill; 2008. p. 569–88.Google Scholar
  19. 19.
    Kang N, Hsee L, Rizoli S, Alison P. Penetrating cardiac injury: overcoming the limits set by nature. Injury. 2009;40(9):919–27. Scholar
  20. 20.
    Naughton MJ, Brissie RM, Bessey PQ, McEachern MM, Donald JM, Laws HL. Demography of penetrating cardiac trauma. Ann Surg. 1989;209(6):676–81 discussion 682–683.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Demetriades D, van der Veen BW. Penetrating injuries of the heart: experience over two years in South Africa. J Trauma. 1983;23(12):1034–41.CrossRefPubMedGoogle Scholar
  22. 22.
    Barleben A, Huerta S, Mendoza R, Patel CV. Left ventricle injury with a normal pericardial window: case report and review of the literature. J Trauma. 2007;63(2):414–6. Scholar
  23. 23.
    Rhee PM, Foy H, Kaufmann C, et al. Penetrating cardiac injuries: a population-based study. J Trauma. 1998;45(2):366–70.CrossRefPubMedGoogle Scholar
  24. 24.
    Morse BC, Mina MJ, Carr JS, et al. Penetrating cardiac injuries: a 36-year perspective at an urban, Level I trauma center. J Trauma Acute Care Surg. 2016;81(4):623–31. Scholar
  25. 25.
    Topal AE, Celik Y, Eren MN. Predictors of outcome in penetrating cardiac injuries. J Trauma. 2010;69(3):574–8. Scholar
  26. 26.
    Nagy KK, Gilkey SH, Roberts RR, Fildes JJ, Barrett J. Computed tomography screens stable patients at risk for penetrating cardiac injury. Acad Emerg Med. 1996;3(11):1024–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Demetrios A. Raptis
    • 1
    Email author
  • Sanjeev Bhalla
    • 1
  • Constantine A. Raptis
    • 1
  1. 1.Mallinckrodt Institute of RadiologySt. LouisUSA

Personalised recommendations