Blunt cardiac injury without external evidence of thoracic trauma: A report of two pediatric cases. (16th February 2016)

• Record Type: Journal Article
• Authors: Monroe, Dustin E; Willert, Jennifer; Saba, Ziad; Rosenfeld, Howard; Willis, Brigham C
• Is Part Of: Cardiovascular and thoracic open. Volume 2(2016)
• Publication Date: 2016-02-16
• Subjects: television -- trauma -- tricuspid regurgitation -- ventricular septal defect; Cardiovascular system -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; Heart -- Surgery -- Periodicals; 617.41
• DOI: 10.1177/2055552016630491
• Languages: English
• ISSNs: 2055-5520

Abstract

Objective: To report two cases of cardiac injury following blunt thoracic trauma without external evidence of injury. Design: Case report and review of the literature. Setting: A 23-bed pediatric intensive care unit in an academic children's hospital. Interventions: Two children presented following significant thoracic trauma without external evidence of injury. Cardiac injury was not initially suspected, and lack of definitive diagnostic evaluation led to a delay in diagnosis and definitive treatment. Results: A 4-year-old girl presented 6 months after initial injury and evaluation with massive right ventricular dilatation secondary to traumatic tricuspid regurgitation. The second patient, an 11-year-old boy, underwent a laparotomy for suspected abdominal pathology delaying diagnosis of his traumatic ventricular septal defect and definitive repair until clinical hemodynamic deterioration occurred. Conclusion: Clinicians should maintain a high index of suspicion for cardiac injury in patients with a significant mechanism of thoracic trauma despite external evidence. Standard screening tests are often inadequate and echocardiography should be performed for any suspected cardiac trauma.