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Intrapericardial caval injury due to blunt trauma
G L Fey1, M M Deren, J H Wesolek
1St. George's University, School of Medicine, Grenada, West Indies.
Connecticut Medicine
|June 11, 1999
Summary
Blunt thoracic trauma can cause cardiac tamponade due to intrapericardial inferior vena cava injury. Median sternotomy is the preferred surgical approach for repairing this rare but critical injury.
Area of Science:
- Trauma Surgery
- Cardiovascular Surgery
- Emergency Medicine
Background:
- Blunt thoracic trauma is an uncommon cause of cardiac tamponade.
- Intrapericardial inferior vena cava (IVC) injury presents a diagnostic and therapeutic challenge.
Observation:
- A 43-year-old male, a victim of a motor vehicle accident, presented with hypotension and tachycardia.
- Clinical presentation lacked external chest trauma signs, complicating initial diagnosis.
Findings:
- Ultrasound revealed cardiac tamponade and abdominal fluid; pericardiocentesis yielded nonclotted blood.
- Laparotomy identified intra-abdominal bleeding and splenic injury; sternotomy confirmed and repaired an IVC laceration.
Implications:
- Deceleration injuries causing blunt thoracic trauma should raise suspicion for intrapericardial IVC injury.
- Median sternotomy offers optimal surgical access for the repair of IVC injuries.