Undiagnosed Myocardial Tear Blocked by an Omental Plug: Potentially Lifethreatening Condition

Abstract

Blunt chest trauma carries a high mortality when associated with cardiac rupture. Rapid diagnosis represents a true challenge for clinicians, with CT scan examination playing a central role. We report a case of a traumatic myocardial tear, plugged by the greater omentum through a diaphragmatic rent in an hemodynamically stable patient. This condition, identified during laparoscopy, was not suspected preoperatively at both clinical examination and CT. This case illustrates that a transparietal cardiac rupture can be sealed off by surrounding structures. This phenomenon explains why CT can be unable to detect traumatic cardiac rupture, with the potential risk of a delayed fatal bleeding. This case also emphasizes the risk of using laparoscopy in traumatic diaphragm rupture repair.