CARDIAC HERNIATION PRODUCING TAMPONADE - THE CRITICAL ROLE OF EARLY DIAGNOSIS

Background: Rupture of the pleuropericardium (PP) occurs rarely, with most patients dying of associated injuries before arriving at the hosp ital, Among patients who initially survive, the diagnosis is often del ayed until cardiogenic shock secondary to cardiac herniation is eviden t, Methods: The records of 10 patients with PP lacerations and cardiac herniations were reviewed, Results: All but one patient had a normal chest x-ray (CXR) film on admission, After the patients became symptom atic, seven of nine had abnormal findings on CXR film demonstrating he rniation of the heart into the left hemithorax, The other two patients underwent surgery without a repeat CXR Nm, Except for one who was tak en directly to the operating room, all patients had been previously st abilized before developing cardiogenic shock, on average 9 hours after admission, Operative therapy was closure of the pericardium for five patients and completion pericardiotomy for the others, All survivors d eveloped significant complications, and four of them died, Conclusions : The diagnosis of PP rupture should be considered for patients with m ultiple trauma who develop sudden and unexpected cardiogenic shock aft er their initial condition has been stabilized, A repeat CXR film is d iagnostic in most cases and should be used as the most efficient and e xpeditious route to making the diagnosis.