Combined blunt cardiac and pericardial rupture: Review of the literature and report of a new diagnostic algorithm

The spectrum of blunt cardiac injury varies from the asymptomatic cardiac c oncussion to the immediately fatal cardiac rupture. Although the majority o f victims sustaining blunt cardiac rupture die before receiving medical att ention, some survive to evaluation. The diagnosis of cardiac rupture, if es tablished, typically results from the signs and symptoms of pericardial tam ponade. However, some patients may have remarkably few signs and symptoms s uggestive of cardiac injury and represent a significant diagnostic challeng e. We provide two cases of cardiac rupture in which the diagnosis was delay ed by the presence of an associated pericardial tear with decompression int o the mediastinum and pleural space. In neither of the cases did existing i nstitutional algorithms for blunt cardiac injury assist in establishing the diagnosis before the acute demise of the patient. The presence of a coexis ting pericardial injury in these patients with blunt cardiac rupture obscur ed the diagnosis, leading to the deaths of these patients. A discussion of these two cases and review of the literature is provided with recommendatio ns for diagnostic algorithms in patients sustaining blunt thoracic trauma w ith possible cardiac and pericardial injury.