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Traumatic cardiac rupture with cerebral herniation: A case report
Yi Zhu1, Xinhe Huang2, Zheng Zhu1
1Department of Cardiothoracic Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
Rationale:
Traumatic cardiac rupture with concurrent cerebral herniation represents a critical emergency characterized by an extremely high prehospital mortality rate. Early diagnosis and multidisciplinary intervention are essential for survival. As this is a single-case report, the observations should be interpreted with caution.
Patient Concerns:
A 45-year-old woman presented in a coma with hemorrhagic shock following a traffic accident. Imaging revealed a massive left hemothorax, multiple rib fractures, and a right subdural hematoma with a 10 mm midline shift.
Diagnosis:
Emergency surgery confirmed the diagnoses of cardiac rupture and cerebral herniation.
Interventions:
Damage-control surgery was initiated within 2 hours and included emergency thoracotomy for cardiac repair and decompressive craniectomy.
Outcome:
The patient was discharged on postoperative day 54. During follow-up, she exhibited no delayed cardiac complications on echocardiography.
Lessons:
This case is notable for the rare concurrence of traumatic cardiac rupture and evolving cerebral herniation, necessitating staged, back-to-back thoracotomy and decompressive craniectomy. Early recognition, multidisciplinary coordination, and adherence to damage-control sequencing were essential for survival.
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