Department of Anaesthesia and Intensive care, The Royal London Hospital, Whitechapel, E1 1BB, UK.
Scand J Trauma Resusc Emerg Med. 2009 Dec 15;17:64. doi: 10.1186/1757-7241-17-64.
Blunt Traumatic Pericardial Rupture (BTPR) with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%.
We present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injury
BTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with:Cardiovascular instability with no obvious cause. Prominent or displaced cardiac silhouette and asymmetrical large volume pneumopericardium. Potentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest.
钝性心脏创伤性心包破裂（BTPR）导致心脏疝出是一种罕见且常致命的情况。尽管过去的文献中有大量关于这种情况的病例报告，但反复出现的主题是漏诊。在严重钝性创伤中，其发生率约为 0.4%。这种损伤经常导致生前/早期医院死亡和尸检诊断，可能是由于诊断困难、缺乏熟悉和相关多发伤的综合因素所致。在存活到医院就诊的患者中，死亡率约为 57-64%。
我们介绍了两名 BTPR 和心脏疝出的幸存者，其中一名是继发于肋骨骨折的迟发性穿透性心脏损伤。通过这两个病例和文献复习，我们希望提高对这种损伤的认识。
BTPR 和心脏疝出是一种复杂且常致命的损伤，通常在多发伤的保护伞下出现。临床医生必须对 BTPR 保持高度怀疑，但即使如此，诊断也充满困难。在钝性胸部创伤中，当患者出现以下情况时，应被视为 BTPR 的高风险：无明显原因的心血管不稳定。明显或移位的心影和不对称的大容量心包积气。可能随着对损伤的认识提高，以及成像方式的改进使用和可用性，生存率将提高，心脏疝出甚至可以被认为是可逆转原因引起的钝性创伤性 PEA 骤停的第 5 个 H。
