Pneumopericardium should be considered with electrocardiogram changes after blunt chest trauma: a case report

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Abstract

Introduction

Electrocardiogram (ECG) abnormalities in patients with blunt chest trauma are diverse and non-specific, but may be indicative of potentially life-threatening conditions.

Case presentation

We report a rare case of pneumopericardium with extreme ECG abnormalities after blunt chest trauma in a 22-year-old male. The diagnosis was confirmed using computed tomography (CT) scanning. The case is discussed, together with its differential diagnosis and the aetiology of pneumopericardium and tension pneumopericardium.

Conclusion

Pneumopericardium should be distinguished from other pathologies such as myocardial contusion and myocardial infarction because of the possible development of tension pneumopericardium. Early CT scanning is important in the evaluation of blunt chest trauma.

Related collections

Most cited references 9

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Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT--initial experience.

Brian W. Kirkpatrick, John R Mayo, Kevin E Forkheim … (2002)

To prospectively compare the accuracy of ultrasonography (US) with that of supine chest radiography in the detection of traumatic pneumothoraces, with computed tomography (CT) as the reference standard. Thoracic US, supine chest radiography, and CT were performed to assess for pneumothorax in 27 patients who sustained blunt thoracic trauma. US and radiographic findings were compared with CT findings, the reference standard, for pneumothorax detection. For the purpose of this study, the sonographers were blinded to the radiographic and CT findings. Eleven of 27 patients had pneumothorax at CT. All 11 of these pneumothoraces were detected at US, and four were seen at supine chest radiography. In the one false-positive US case, the patient was shown to have substantial bullous emphysema at CT. Sensitivity and negative predictive value of US were 100% (11 of 11 and 15 of 15 patients, respectively), specificity was 94% (15 of 16 patients), and positive predictive value was 92% (11 of 12 patients). Chest radiography had 36% (four of 11 patients) sensitivity, 100% (16 of 16 patients) specificity, a 100% (four of four patients) positive predictive value, and a 70% (16 of 23 patients) negative predictive value. In this study, US was more sensitive than supine chest radiography and as sensitive as CT in the detection of traumatic pneumothoraces.

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Continuous left hemidiaphragm sign revisited: a case of spontaneous pneumopericardium and literature review.

Bradley Ramsay, R Graeni, Benjamin Peter … (2002)

In pneumopericardium, a rare but potentially life threatening differential diagnosis of chest pain with a broad variety of causes, rapid diagnosis and adequate treatment are crucial. In upright posteroanterior chest radiography, the apical limit of a radiolucent rim, outlining both the left ventricle and the right atrium, lies at the level of the pulmonary artery and ascending aorta, reflecting the anatomical limits of the pericardium. The band of gas surrounding the heart may outline the normally invisible parts of the diaphragm, producing the continuous left hemidiaphragm sign in an upright lateral chest radiograph. If haemodynamic conditions are stable, the underlying condition should be treated and the patient should be monitored closely. Acute haemodynamic deterioration should prompt rapid further investigation and cardiac tamponade must be actively ruled out. Spontaneous pneumopericardium in a 20 year old man is presented, and its pathophysiology described.

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The usefulness of serum troponin levels in evaluating cardiac injury.

L Weireter, F Cole, L Britt … (2001)

The diagnosis and clinical significance of blunt cardiac injury remains controversial. Cardiac troponin I is not found in skeletal muscle and has a high sensitivity for myocardial ischemia or injury. We hypothesized that normal troponin levels 4 to 6 hours postinjury would effectively exclude the diagnosis of cardiac contusion. A prospective evaluation of all blunt trauma patients older than 16 and admitted with the possible diagnosis of blunt cardiac injury was undertaken. Patients in whom this diagnosis was considered had an electrocardiogram (EKG) on admission, serum troponin, CPK and isoenzymes 4 to 6 hours postinjury, and admission with overnight telemetry. Other laboratory data and radiographic imaging was obtained as indicated. Seventy-two patients met criteria for entry into the study. Data was incomplete or inaccurately obtained on six patients, and they were excluded. Forty patients had normal troponins and normal EKG's on admission and were discharged the following day without any untoward effect. Sixteen patients were admitted with abnormal EKGs. All of these 16 patients had normal troponins 4 to 6 hours after their injury. They all did well and were discharged the following day. Ten patients had elevated troponins 4 to 6 hours after injury. One died two days later from refractory cardiogenic shock. Another was noted to have severely depressed left ventricular function by echocardiography. The other eight patients sustained no cardiac sequelae and were discharged once recovered from injuries. In the hemodynamically stable patient a normal troponin 4 to 6 hours after injury excludes clinically significant blunt cardiac injury. This holds true whether the admission EKG is normal or not. An elevated troponin does not definitively diagnose a clinically significant contusion. However, these patients should be monitored at least for 24 hours. Patients suspicious for cardiac contusions who have normal troponins and no other serious injuries may be safely discharged to go home from the emergency department.

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Author and article information

Journal

Journal ID (nlm-ta): J Med Case Reports

Title: Journal of Medical Case Reports

Publisher: BioMed Central

ISSN (Electronic): 1752-1947

Publication date Collection: 2008

Publication date (Electronic): 4 April 2008

Volume: 2

Page: 100

Affiliations

[1 ]Department of Intensive Care, Medical Centre Leeuwarden, 8901 BR, Leeuwarden, The Netherlands

[2 ]Department of Intensive Care, Academic Medical Centre, 1100 DD, Amsterdam, The Netherlands

Article

Publisher ID: 1752-1947-2-100

DOI: 10.1186/1752-1947-2-100

PMC ID: 2323010

PubMed ID: 18394149

SO-VID: 5108eb80-68c4-4e9d-b398-19f35d3f498e

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Pneumopericardium should be considered with electrocardiogram changes after blunt chest trauma: a case report

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Abstract

Introduction

Case presentation

Conclusion

Related collections

European Journal of Medical Case Reports (EJMCR)

Most cited references 9

Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT--initial experience.

Continuous left hemidiaphragm sign revisited: a case of spontaneous pneumopericardium and literature review.

The usefulness of serum troponin levels in evaluating cardiac injury.

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