Dheeraj Abhaykumar B, Kumar Giri Sandeep Kumar Giri, Akhade Swapnil P, Sahu Kavyesh, Pal Vijay, Hussain Nighat
All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
Department of Forensic Medicine and Toxicology, Kalpana Chawala Medical College and Hospital, Karnal, Haryana, India.
Arch Med Sadowej Kryminol. 2022;72(3):151-157. doi: 10.4467/16891716AMSIK.22.018.17396.
The literature reports cases of ventricular rupture in blunt chest trauma following motor vehicle accidents. It rarely describes cardiac tamponade due to rupture of the heart following blunt thoracic trauma in a physical assault. There are rare cases where fatal cardiac tamponade results from a ruptured ventricle without externally visible injuries to the chest. It is also rare for the cardiac rupture to occur on the posterior side. In our case series, the first case involved a direct blow to the left side of the chest by a projectile (brick), causing rupture of the left ventricle's base with intact pericardium. In the second case, a direct blow to the left side of the chest led to rupture of the right ventricle's posterior wall.
Here, we report two autopsy-based case series of isolated right and left ventricular rupture with cardiac tamponade in blunt thoracic trauma with a specific history and background information of assault. The first case is a 35-year-old male assaulted with a brick thrown at his chest in a moving bus; he was declared dead on arrival after a one-hour journey. The second case is a 55-year-old male assaulted with double punches in his chest and declared dead on arrival at the hospital after 30 minutes. A medicolegal autopsy and thorough investigation, in both cases, revealed cardiac tamponade due to ventricular rupture with no underlying pathology.
This case series underlines the importance of systematic and complete cardiac examination in all death cases following blunt chest trauma even with minimal or no evidence of a visible injury to the chest. Rarely cardiac rupture is noticed on the posterior surface or apex of the heart. The case series illustrates a rare occurrence of cardiac rupture that requires apt investigation and certification of medicolegal causes of death to determine how the death was caused.
文献报道了机动车事故后钝性胸部创伤导致心室破裂的病例。但很少描述在人身攻击中钝性胸部创伤后心脏破裂引起的心包填塞。罕见情况下，心室破裂导致致命的心包填塞，而胸部没有外部可见损伤。心脏破裂发生在心脏后侧的情况也很少见。在我们的病例系列中，第一例是胸部左侧被投射物（砖块）直接击中，导致左心室基部破裂，心包完整。第二例是胸部左侧被直接击中，导致右心室后壁破裂。
在此，我们报告两个基于尸检的病例系列，均为钝性胸部创伤中孤立的右心室和左心室破裂并伴有心包填塞，且有特定的攻击病史和背景信息。第一例是一名35岁男性，在一辆行驶的公交车上胸部被扔来的砖块袭击；经过一小时的行程后，他在到达时被宣布死亡。第二例是一名55岁男性，胸部被连击两拳，30分钟后在到达医院时被宣布死亡。两例均进行了法医学尸检和全面调查，结果显示为心室破裂导致心包填塞，无潜在病理状况。
本病例系列强调了在所有钝性胸部创伤后的死亡病例中进行系统全面心脏检查的重要性，即使胸部仅有轻微或无可见损伤迹象。心脏破裂很少发生在心脏后表面或心尖。该病例系列说明了一种罕见的心脏破裂情况，需要进行恰当的调查并对法医学死因进行认证，以确定死亡原因。
