Traumatic Atrial Septal Defect with Tricuspid Regurgitation Following Blunt Chest Trauma Presenting as Hypoxemia: A...

Although myocardial injury is common after blunt chest trauma, tricuspid valve injury associated with traumatic atrial septal defect resulting in acute hypoxia is an infrequent event. We report an unusual case of blunt chest trauma referred to us for unexplained hypoxemia, emphasizing the unusual nature of injury and the importance of comprehensive cardiac evaluation in such cases.

A 35-year-old male presented to the emergency department after falling from a tree from an approximate height of 15 feet. He sustained multiple rib fractures and a left hemopneumothorax. Examination revealed decreased air entry over the left hemithorax and a systolic murmur over the left sternal border. Electrocardiography showed a junctional rhythm, and troponin levels were significantly elevated. Despite tube thoracostomy, the patient remained hypoxemic. Cardiology evaluation revealed a flail tricuspid valve with severe regurgitation and a traumatic atrial septal defect (ASD). Bidirectional shunting across the atrial septal defect was causing hypoxemia. The patient underwent surgical repair of the ASD and tricuspid valve, which resulted in a successful outcome.

Our case highlights the need for comprehensive cardiac evaluation in such patients. In addition to sonography for trauma, point-of-care echocardiographic examination should be a part of the focused assessment.