[Cardiac rupture in thoracic trauma]

Thoracic trauma frequently involve damage to the cardiac structures and in the worst cases, the progressive degeneration and necrosis of the damaged tissue lead to cardiac rupture. The high mortality resulting from cardiac tamponade requires the prompt execution of diagnostic tests to provide as much useful information as rapidly as possible in order to start immediate therapy. A case of cardiac rupture manifested by the onset of atrial fibrillation in a patient admitted to Intensive Care after a car accident is described. The scarce significance of objective examination, the aspecific nature of chest X-ray and ECG alterations prompted the execution of a more thorough diagnosis. Transthoracic and transesophageal ultrasonography are both minimally invasive and highly specific: in a short time, not only did they confirm cardiac rupture, but they also focalised the site of the lesion, thus allowing a more targeted and rapid surgical approach. The relative frequency of cardiac lesions following closed thoracic trauma, the lack of incontrovertible signs and symptoms of late cardiac rupture, and the extreme severity of its clinical consequences argue in favour of using specific and sensitive diagnostic tests that can not only exclude or ascertain the presence of these lesions, but also allow subsequent serial controls aimed at diagnosing late cardiac ruptures.