Extrapericardial cardiac tamponade caused by traumatic retrosternal hematoma

Cardiac tamponade is an uncommon complication of blunt chest trauma, result ing typically from hemorrhage into the pericardial space. We report a case of hemodynamic compromise secondary to an extrapericardial compression caus ed by the acute formation of a retrosternal hematoma associated with a ster nal fracture. The patient was involved in a violent deceleration accident. Initially, he only complained of an anterior thoracic pain, but subsequentl y became restless, pale, and dyspneic. A severe hypotension associated with sinus bradycardia (45 bpm) rapidly occurred. Both jugular veins became mar kedly turgescent, but no significant pulsus paradoxus was noted. Echocardio graphy disclosed a large hematoma, compressing anteriorly both the right ve ntricular cavity and outflow tract. Surgical evacuation of the retrosternal hematoma related to a bifocal fracture of the manubrium was followed by in stantaneous hemodynamic improvement. Regional extrapericardial tamponade se condary to the acute formation of compressive retrosternal hematoma is an u nusual cause of circulatory failure after severe blunt chest trauma. Since conventional clinical signs associated with typical tamponade physiology ma y be lacking in this setting, echocardiography is ideally suited for early recognition of this unusual condition.