A Young Patient With Gunshot Wounds

Cardiac herniation secondary to pericardial rupture is a rare but life-threatening complication of severe chest trauma. Prompt recognition is critical, as the initial imaging findings can be subtle, and delayed diagnosis often results in rapid clinical deterioration.

To highlight the importance of early diagnosis and intervention in cases of cardiac herniation following traumatic pericardial rupture, with a focus on recognizing key radiographic and computed tomography findings that can guide emergent management.

A 20-year-old male presented after sustaining multiple gunshot wounds, including penetrating injuries to the left chest and back. On arrival, he was in hemorrhagic shock, exhibiting tachycardia and hypotension. Initial chest radiography demonstrated mediastinal and cardiac displacement into the left hemithorax, with the absence of the right heart border. Further evaluation with chest CT confirmed levocardia with cardiac levorotation, right pulmonary artery kinking, left atrial compression, and pneumopericardium. The patient subsequently underwent an emergency thoracotomy where a large pericardial rupture with cardiac herniation was confirmed. The heart was manually repositioned and the pericardial defect was securely sutured.

This case underscores the critical role of early imaging in diagnosing cardiac herniation, a condition often associated with high mortality.