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Echocardiogram in sternal fracture
Y Wiener1, B Achildiev, T Karni
1Department of General Surgery B, Assaf Harofeh Medical Center, Zeriffin, Israel. wiyiya@inter.net.il
Insights
Echocardiogram (ECHO) is vital for diagnosing myocardial contusion in sternal fracture patients. "Benign" pericardial effusions detected by ECHO do not require prolonged observation.
Area of Science:
- Cardiology
- Trauma Surgery
- Emergency Medicine
Background:
- Sternal fractures often result from blunt chest trauma.
- Cardiac complications following sternal fractures require accurate diagnosis.
Purpose of the Study:
- To assess the utility of electrocardiogram, creatine kinase MB isoenzyme, and echocardiogram (ECHO) in diagnosing myocardial contusion in patients with sternal fractures.
- To evaluate the incidence and significance of pericardial effusion in this patient population.
Main Methods:
- Retrospective review of 50 consecutive patients with sternal fractures due to blunt chest trauma.
- Analysis of cardiac test results including electrocardiogram, creatine kinase MB isoenzyme, and echocardiogram (ECHO).
Main Results:
- 22% of patients had abnormal cardiac tests; only 6% had symptomatic myocardial contusion.
- Echocardiogram (ECHO) identified myocardial contusion in one case where other tests were normal.
- 22.5% of ECHO studies revealed pericardial effusion, often without clinical significance or association with injury severity.
Conclusions:
- Echocardiogram (ECHO) is a valuable diagnostic and triage tool for sternal fracture patients with associated injuries.
- Patients with "benign" pericardial effusion identified by ECHO can be discharged once medically stable.
Abstract:
We reviewed the records of 50 consecutive patients presenting with sternal fracture after blunt chest trauma. The relationships between electrocardiogram, creatine kinase MB isoenzyme and echocardiogram (ECHO) were assessed in reference to myocardial contusion. Eleven patients (22%) had 1 or more abnormal cardiac tests but only 3 (6%) had clinically symptomatic myocardial contusion. Seven (22.5%) out of 31 ECHO studies revealed pericardial effusion which was not associated with the severity of all other associated injuries. The incidence of an abnormal ECHO study in patients with isolated sternal fracture was similar to that of patients who suffered multiple injuries. In 5 patients with pericardial effusion, this finding was not associated with any other abnormal tests and was regarded as of no clinical cardiac significance. On the other hand, a myocardial contusion was shown by ECHO examination only while echocardiogram and creatine kinase MB tests remained normal in that patient. We suggest that the ECHO should be used as a diagnostic and triage tool in every patient with sternal fracture associated with other injuries. However, patients with "benign" pericardial effusion can be discharged as soon as their medical condition improves regardless of other associated injuries.