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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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CASE REPORTS  CARDIAC SECTION


The Journal of Cardiovascular Surgery 2001 October;42(5):621-4

language: English

Extrapericardial cardiac tamponade caused by traumatic retrosternal hematoma

Rambaud G., Desachy A., François B., Allot V., Cornu E. *, Vignon P.

From the Intensive Care Unit
*Thoracic and Cardiovascular Surgery Dupuytren University Hospital, Limoges (France)


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

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