Cardiac laceration without any external chest injury in an otherwise healthy myocardium - a case series

Area of Science:

• Forensic Pathology
• Cardiovascular Medicine
• Trauma Surgery

Background:

• The heart's protected location in the thoracic cavity makes cardiac lacerations rare in blunt chest trauma.
• Unexplained deaths following blunt trauma necessitate thorough investigation, including autopsy.

Observation:

• Three autopsy cases of sudden death from blunt chest trauma were identified.
• These cases lacked external chest injuries but showed hemopericardium due to cardiac chamber rupture.
• The rapid accumulation of blood caused fatal cardiac tamponade.

Findings:

• Cardiac chamber rupture is a potential, albeit uncommon, consequence of blunt chest trauma.
• Hemopericardium resulting from cardiac rupture can rapidly lead to death via tamponade.
• Absence of external chest injury does not exclude severe internal cardiac trauma.

Implications:

• Emphasizes the critical need for complete autopsies in all blunt trauma fatalities, regardless of external signs.
• Highlights the importance of suspecting and ruling out myocardial injury in living patients with blunt chest trauma, even without visible wounds.
• Underscores the diagnostic challenge and potential severity of internal cardiac injuries following non-penetrating chest trauma.