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J Thorac Cardiovasc Surg 2005;130:e9-e10
© 2005 The American Association for Thoracic Surgery

Brief Communications

Pericardiodiaphragmatic rupture and cardiac herniation after multiple blunt trauma: Diagnostic and therapeutic difficulties

Z. Witkowski, PhD a , * , J. Lasek, MD a , M. Wujtewicz, PhD b , M. Stasiak, PhD a , W. Marks, MD a , A. Kawecka, MD a

a Departments of Trauma Surgery
b Intensive Therapy, Medical University of Gdansk, Gdansk, Poland

* Address for reprints: Zbigniew Witkowski, Department of Trauma Surgery, Medical University of Gdansk, ul. Debinki 7, 80-211 Gdansk, Poland (Email: zwit@amg.gda.pl).

The first 20% of the full text of this article appears below.

Pericardial rupture with cardiac herniation (CH) after severe multiple trauma is observed rarely and frequently is diagnosed during postmortem examinations. Fulda and associates 1 Go described 4 patients with pericardiodiaphragmatic rupture (PDR); however, no CH was observed among 20000 trauma patients in their materials. The overall morbidity rate in patients with PDR is high, mainly in multiply injured victims. 1,2 Go We describe a report of a successful treatment of a multiply injured patient who sustained PDR and CH.

Clinical Summary

A 55-year-old woman was transferred to our university trauma surgery unit from a local hospital about 14 days after a car accident in which 3 other persons died. After the crash, the patient was in shock (blood pressure, 60/0 mm Hg; heart rate, >140 beats/min). The initial chest radiograph showed pneumothorax and rib fractures VI-X of the left side and fractures of both clavicles. Left-side pleural drainage was installed, and an emergency laparotomy was introduced. It revealed a diaphragmatic rupture about 15 cm long on the left side, with herniation of a severely injured spleen and large intestine (flexura lienalis) into the pleural cavity. Because of the severe . . . [Full Text of this Article]






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