[Myocardial contusion after blunt thoracic trauma: possible indication for rhythm observation]

A 65-year-old man had a pneumohaemothorax and fractured ribs after an automobile accident. Troponine concentrations were normal and the initial electrocardiographic abnormalities resolved within 24 hours. A 46-year-old man who was also in an automobile accident developed a seat-belt haematoma and lung oedema. Troponine concentrations were increased, the electrocardiogram was abnormal and transthoracic ultrasound revealed severe myocardial contusion. After a few weeks of treatment, both patients were discharged without cardiac complications. It is clinically important to identify patients at risk of developing myocardial contusion following blunt thoracic trauma. A combination oftroponine and electrocardiography is necessary to differentiate between risk categories. Echocardiography has a role in haemodynamically unstable patients and whenever the clinical condition of the patient deteriorates. A structured approach to screening and evaluation, as presented in an algorithm, can be used as a guide in the follow-up of patients with myocardial contusion.