Penetrating Chest Trauma With Right Atrial Rupture: A Case Report

Penetrating thoracic injuries, especially those affecting cardiac structures, are rare but can be life-threatening, requiring urgent medical care. Right atrium injuries pose significant risks, including rapid blood loss, cardiac tamponade, hemodynamic instability, and, subsequently, potential death. We report the case of a 24-year-old male patient with stab wounds leading to a right-sided chest penetration three hours prior to presentation. The patient exhibited hypotension, tachycardia, and mild respiratory distress upon arrival. The patient had a 1.5x3 cm penetrating injury in the right fourth intercostal space and another 1x3 cm incision in the fifth intercostal region. A right chest tube was inserted, draining 500 milliliters of hemothorax, and continued to increase without improvement in the patient's condition. The patient was quickly taken to the operating room after initial resuscitation with fluids and blood transfusion, where the abdominal diagnostic laparoscopy was negative, but a thoracotomy revealed hemopericardium and a 2x3 cm right atrial rupture. A tangential Satinsky clamp and a double-layered 5-0 double-arm polypropylene suture were utilized to achieve hemostasis during repair. The patient was extubated successfully on the first postoperative day and discharged in stable condition on the ninth day. This case underscores the importance of prompt diagnosis and surgical management in cases of penetrating cardiac trauma. Even in resource-limited settings, managing right atrial rupture can be effectively achieved through rapid resuscitation, proper imaging, and skilled surgical techniques.