Delayed pericardial effusion following stab wounds to the chest

Delayed pericardial effusion following penetrating cardiac trauma has not been commonly reported, and the exact incidence remains unknown. It was more common before 1960, when pericardiocentesis was still a popular treatment for stable patients presenting with a stab wound to the heart.

During an 8-year period, 24 patients were diagnosed with delayed pericardial effusions following a recent stab wound over the chest. Nine patients had been initially treated at our trauma unit, and the remaining 15 patients were referred by a peripheral clinic.

Diagnosis was confirmed by cardiac ultrasound or echocardiogram. Sixteen patients were adequately treated by subxiphoid drainage. Sternotomy was performed in five patients, left thoracotomy in two and right thoracotomy in one patient. No actively bleeding injuries were found. Three patients had active infection in the pericardial space. Fever, pleural effusions and ascites were common associated findings. Additional procedures performed included laparotomy for acute abdominal pain in two patients (both negative), and simultaneous drainage of a pleural empyema. Two patients with staphylococcal pericardial infections required subsequent pericardiectomy.

The diagnosis of a penetrating cardiac patient may be missed in a stable patient, and patients may present with delayed pericardial effusions and tamponade. Post pericardiotomy syndrome may be the most common cause of delayed pericardial effusion, followed by sepsis. Subxiphoid pericardial window is an adequate form of treatment. Recent literature reveals that occult cardiac injury is not uncommon, thus a case should be made to actively investigate all patients with precordial stab wounds with cardiac ultrasound or echocardiogram.