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Cardiac contusion in pediatric patients with blunt thoracic trauma
S T Ildstad1, D J Tollerud, R G Weiss
1Department of Pediatric Surgery, Children's Hospital Medical Center, Cincinnati, OH.
Insights
Blunt chest trauma in children can frequently cause myocardial contusion, a heart injury. A multiple-gated acquisition (MUGA) scan effectively detects this damage in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Trauma Surgery
- Diagnostic Imaging
Background:
- Blunt chest trauma is a significant cause of injury in children.
- Myocardial contusion prevalence and diagnostic methods in pediatric blunt chest trauma require further investigation.
Purpose of the Study:
- To determine the incidence of myocardial contusion in pediatric patients with blunt thoracic trauma.
- To evaluate diagnostic tools for detecting cardiac injury in this population.
Main Methods:
- Prospective evaluation of pediatric patients (2.5-18 years) with blunt thoracic trauma.
- Cardiac assessment included multiple-gated acquisition (MUGA) scans, serial electrocardiograms (ECG), and cardiac enzyme levels (creatine phosphokinase [CPK] and isoenzymes).
Main Results:
- Seven pediatric patients with pulmonary contusion or rib fractures were identified.
- Cardiac contusion was diagnosed in 43% (3/7) of patients, characterized by abnormal ventricular function and reduced ejection fraction on MUGA scan, confirmed by elevated cardiac enzymes.
- No ECG abnormalities were observed in pediatric patients, unlike in adults.
Conclusions:
- Myocardial contusion is a frequent complication of significant blunt thoracic trauma in children.
- MUGA scan is a valuable, noninvasive tool for assessing cardiac damage in pediatric blunt chest trauma.
- Further research is needed to understand the clinical significance and long-term effects of myocardial contusion in children.
Abstract:
To investigate the prevalence of myocardial contusion associated with blunt chest trauma in the pediatric age group, all patients admitted to our institution during a 6-month period with blunt thoracic trauma severe enough to produce a pulmonary contusion or rib fracture were prospectively evaluated. Cardiac evaluation was undertaken, including a multiple-gated acquisition (MUGA) cardiac scan, serial electrocardiograms (ECG), and serum creatine phosphokinase (CPK) and CPK isoenzymes. Seven patients, ranging in age from 2 1/2 to 18 years, with rib fractures or pulmonary contusion by chest roentgenograph were identified. One patient was injured as a passenger in a motor vehicle accident, five were struck by automobiles as pedestrians, and one sustained traumatic asphyxia when a car, supported by a jack, fell on his chest. All had at least one other major organ system injured. All patients had pulmonary contusions as determined by chest radiograph, and two had associated rib fractures. In 43% (three of seven) of patients, a significant cardiac contusion was identified, defined by abnormal right or left ventricular wall motion and a decreased ejection fraction on MUGA scan, and confirmed by an increase in cardiac enzymes and isoenzymes. However, in contrast with adults, no patients had ECG abnormalities. This limited series suggests that cardiac contusion may occur frequently in pediatric patients who have suffered from blunt thoracic trauma significant enough to result in pulmonary contusion. An MUGA scan provides a rapid, noninvasive assessment of cardiac damage in this setting. Further studies will be required to determine the clinical significance and long-term consequences of traumatic myocardial damage in the pediatric population.