Survivor of Right Atrial Appendage Rupture Following Blunt Chest Trauma

Area of Science:

• Trauma Surgery
• Cardiovascular Surgery
• Emergency Medicine

Background:

• Blunt cardiac rupture is a rare and often fatal injury.
• Deceleration injuries from motor vehicle collisions pose a significant risk.
• External signs of trauma are not always present in severe internal injuries.

Observation:

• A 20-year-old restrained driver presented with tachycardia, tachypnea, and hypotension post-high-speed collision.
• Initial trauma evaluations (FAST, chest x-ray) were inconclusive, but a subsequent FAST revealed possible pericardial fluid.
• Computed tomography confirmed a large hemopericardium, indicating cardiac injury.

Findings:

• Emergent median sternotomy revealed a 1 cm right atrial appendage avulsion.
• The avulsion was successfully repaired primarily.
• The patient recovered fully and was discharged.

Implications:

• This case highlights that survival from blunt cardiac rupture is possible, even with severe injuries.
• Maintaining a high clinical suspicion for blunt cardiac injury in unstable trauma patients is critical.
• The low-pressure nature of the right atrium may have facilitated survival in this instance.