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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.
Background:
Report of diagnosis and treatment of intrapericardial vena caval injury caused by blunt thoracic trauma, an unusual cause of cardiac tamponade.
Methods:
A 43-year-old male motor vehicle accident victim suffered a lacerated intrapericardial inferior vena cava leading to cardiac tamponade. Positive clinical findings were hypotension and tachycardia without indication of external chest trauma.
Results:
Abdominal computed tomography was negative, but ultrasound demonstrated cardiac tamponade and fluid in the abdomen. Pericardiocentesis was performed, and nonclotted blood was aspirated. Laparotomy showed intra-abdominal blood and splenic capsule avulsion. Sternotomy revealed a laceration of the inferior vena cava, which was repaired.
Conclusions:
Signs of cardiac tamponade and a history of blunt thoracic trauma caused by deceleration injury suggests intrapericardial inferior vena cava injury. Median sternotomy is the optimal choice for caval repair.