Case Report

Delayed Hemopericardium After Penetrating Chest Trauma: Thoracoscopic Pericardial Window as a Therapeutic Option

Authors: Manuel Caceres, MD, Kennan Buechter, MD, Jaime A. Rodriguez, MD, Donald Liu, MD, PHD

Abstract

A 41-year-old male developed a hemothorax after sustaining a stab wound in the right chest. The patient was managed conservatively with thoracostomy tube drainage for 3 days and was subsequently discharged home. Two weeks later the patient returned to the hospital with pleuritic chest pain and shortness of breath. Imaging studies revealed a right-sided pleural effusion and an enlarged cardiac silhouette, which was consistent with pericardial effusion as per ultrasonography. Thoracoscopic exploration revealed an enlarged heart, that following pericardiotomy drained 400 mL of frank blood. Subsequently, cardiac contractility improved, and no further bleeding was evident.


Key Points


* Thoracoscopic drainage of delayed hemopericardium following penetrating thoracic trauma is an acceptable therapeutic approach.


* Delayed hemopericardium, even though unusual, is possible in the setting of penetrating thoracic injuries.


* Hemopericardium can be missed, particularly when FAST scan is not used in the initial assessment.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Demetriades D, Van der Veen BW. Penetrating injuries of the heart: experience over two years in South Africa. J Trauma 1983;23:1034–1041.
 
2. Sugg WL, Rea WJ, Ecker RR, et al. Penetrating wounds of the heart: an analysis of 459 cases. J Thorac Cardiovasc Surg 1968;56:531–545.
 
3. Aaland MO, Sherman RT. Delayed pericardial tamponade in penetrating chest trauma: case report. J Trauma 1991;31:1563–1565.
 
4. Nataf P, Cacoub P, Regan M, et al. Video-thoracoscopic pericardial window in the diagnosis and treatment of pericardial effusions. Am J Cardiol 1998;82:124–126.
 
5. Morales CH, Salinas CM, Henao CA, et al. Thoracoscopic pericardial window and penetrating chest trauma. J Trauma 1997;42:273–275.
 
6. Liu HP, Chang CH, Lin PJ, et al. Thoracoscopic management of effusive pericardial diseases: indications and technique. Ann Thorac Surg 1994;58:1695–1697.
 
7. Hurley JP, Subarreddy K, McCarthy J, et al. Video-assisted thoracic surgery for delayed pericardial effusion post-CABG. Chest 1994;106:1617–1619.
 
8. Taylor MW, Garber JC, Boswell WC, et al. Delayed hemopericardium and associated pericardial mass after blunt chest trauma. Am Surg 2003;69:343–345.
 
9. Cil E, Senkaya I, Tarim O. Delayed hemopericardium due to trivial chest trauma. Cardiology in the young 1998;8:390–392.
 
10. Bowers P, Harris P, Truesdell S, et al. Delayed hemopericardium and cardiac tamponade after unrecognized chest trauma. Pediatr emerg care 1994;10:222–224.
 
11. Solomon D. Delayed cardiac tamponade after blunt chest trauma: case report. J Trauma1991;31:1322–1324.
 
12. Gershon T, Kuruppu J, Olshaker J. Delayed cardiac tamponade after pacemaker insertion. J Emerg Med 2000;18:355–359.
 
13. Hasegawa J, Noguchi N. Yamasaki J, et al: Delayed cardiac tamponade and hemothorax induced by an acupuncture needle. Cardiology 1991;78:58–63.
 
14. Mason LB, Warshauer SE, Williams RW. Stab wound of the heart with delayed hemopericardium. J Thorac Surg 1954;29:524.
 
15. Vogel B, Mall W. Thoracoscopic pericardial fenestration. Diagnostic and therapeutic aspects.Pneumologie. 1990;44 Suppl 1:184–185.
 
16. Brandt M. Bruckner M. Hirt SW, et al. Thoracoscopic creation of a pericardial window for recurrent pericardial effusion after heart transplantation. Eur J Cardiothorac Surg 1996;10:220–222.
 
17. Mack MJ, Landreneau RJ, Hazelrigg SR, et al. Video-thoracoscopic management of benign and malignant pericardial effusions. Chest 1993;103(Suppl):390S–393S.
 
18. Porter JM. Diagnostic laparoscopy and laparoscopic transdiaphragmatic pericardial window in a patient with an epigastric stab wound: a case report. J Laparoendosc Surg 1996;6:51–54.
 
19. Thourani VH, Feliciano DV, Cooper WA, et al. Penetrating cardiac trauma at an urban center: a 22-year perspective. Am Surg 1999;65:811–818.
 
20. Rozycki GS, Feliciano DV, Ochsner MG, et al. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 1999;46:543–551.
 
21. Meyer DM, Jessen ME, Grayburn PA. Use of echocardiography to detect occult cardiac injury after penetrating thoracic trauma: a prospective study. J Trauma 1995;39:902–907.