- Case report
- Open Access
- Open Peer Review
Traumatic pericardial rupture with skeletonized phrenic nerve
© Khalpey et al; licensee BioMed Central Ltd. 2011
- Received: 8 September 2010
- Accepted: 17 January 2011
- Published: 17 January 2011
Traumatic pericardial rupture is a rare presentation. Pericardial rupture itself is asymptomatic unless complicated by either hemorrhage or herniation of the heart through the defect. Following diagnosis surgical repair of the pericardium is indicated because cardiac herniation may result in vascular collapse and sudden death.
Here we present a case of traumatic, non-herniated pericardial rupture with complete skeletonization of the phrenic nerve.
An 18-year-old healthy male suffered multi-trauma after falling 50 feet onto concrete. The patient could not be stabilized despite exploratory laparotomy with splenectomy, IR embolization and packing for a liver laceration. Right posterolateral thoracotomy revealed a ruptured pericardium with a completely skeletonized phrenic nerve. The pericardium was repaired with a Goretex(R) patch.
A high level of suspicion for pericardial rupture is necessary in all patients with high-velocity thoracic injuries.
- Phrenic Nerve
- Posterolateral Thoracotomy
- Complete Skeletonization
- Liver Laceration
- Vascular Collapse
Traumatic pericardial rupture is a rare presentation. Among 20,000 patients admitted to a major trauma center only 22 were found to have blunt traumatic pericardial rupture . Non-penetrating pericardial rupture most commonly results from deceleration injury . In an autopsy study of 546 consecutive patients with nonpenetrating cardiac trauma, the incidence of isolated pericardial rupture was 3% . Here we present a case of traumatic, non-herniated pericardial rupture with complete skeletonization of the phrenic nerve.
Anatomically, the phrenic nerve is contained within the pericardiophrenic neurovascular bundle, which comprises the nerve, pericardiophrenic artery, and pericardiophrenic vein. This structure, together with its surrounding fat pad offers some protection to the nerve during pericardial rupture. Pericardial rupture itself is asymptomatic unless complicated by either hemorrhage or herniation of the heart through the defect. Physical examination may reveal a characteristic murmur produced by the heart beating in a hemo-pneumopericardium . Radiological investigations provide additional diagnostic information but a definitive diagnosis is usually only made intra-operatively. Surgical repair is indicated because cardiac herniation may result in vascular collapse and sudden death. A high level of suspicion for pericardial rupture is necessary in all patients with high-velocity thoracic injuries.
Informed consent was obtained from the patient for publication of this case report and any accompanying images.
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