Blunt Cardiac Injury Resulting in Avulsion of Septal Myocardium Without Ventricular Septal Defect

An avulsion of the ventricular wall refers to the traumatic tearing or detachment of a portion of the heart's ventricular wall. We report a case involving a man in his 70s with a remote history of seizures, status post (s/p) craniotomy, and a prior gunshot wound to the abdomen s/p exploratory laparotomy with partial colectomy. He presented after sustaining a blunt chest crush injury when a car rolled and pinned him underneath at a mechanic shop. Prognosis in such cases depends on the severity of the injuries. He was found to have an avulsion of the left ventricular septal myocardium without an associated ventricular septal defect or mitral regurgitation. Brain imaging revealed multivessel territory ischemia. Following a multidisciplinary discussion, the patient was managed conservatively with anticoagulation due to the theoretical risk of thrombus formation, along with serial echocardiographic monitoring. Although he remained cardiovascularly stable at discharge, prolonged encephalopathy with persistent ventilator dependence required transfer to a long-term acute care facility.