Blunt Thoracic Trauma-Induced Mitral Papillary Muscle Avulsion with Pericardial Rupture and Cardiac Herniation: Difficult and Delayed Diagnoses

Blunt thoracic trauma (BTT) and the resultant isolated mitral papillary muscle avulsion, pericardial rupture, and cardiac herniation injuries are each rarely diagnosed clinical entities. We describe the first case of combined pericardial tear with cardiac herniation and ruptured mitral papillary muscles following BTT. Preoperative transesophageal echocardiography (TEE) diagnosed the delayed mitral papillary muscle rupture while all previous diagnostic modalities failed to delineate the pericardial rupture and cardiac herniation. Particular emphasis is placed on the clinical and radiologic aspects of the case that would heighten clinical suspicion in the emergency setting where blunt cardiac injury sequelae are suspected and frequently missed.

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Pericardial rupture with cardiac herniation following blunt thoracic trauma

JTCVS Techniques ◽

10.1016/j.xjtc.2020.08.011 ◽

2020 ◽

Vol 4 ◽

pp. 375-377

Author(s):

Nicholas LeBlanc ◽

Lawrence Tan

Keyword(s):

Thoracic Trauma ◽

Blunt Thoracic Trauma ◽

Cardiac Herniation ◽

Pericardial Rupture

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Cardiac herniation after blunt thoracic trauma

Canadian Medical Association Journal ◽

10.1503/cmaj.191446 ◽

2020 ◽

Vol 192 (17) ◽

pp. E454-E454 ◽

Cited By ~ 1

Author(s):

Jonathon Broughton ◽

Duncan Maguire ◽

Nicholas LeBlanc

Keyword(s):

Thoracic Trauma ◽

Blunt Thoracic Trauma ◽

Cardiac Herniation

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Blunt Force Thoracic Trauma: A Case Study of Pericardial Rupture and Associated Cardiac Herniation

Case Reports in Surgery ◽

10.1155/2014/946061 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

O. S. Glotzer ◽

A. Bhakta ◽

T. Fabian

Keyword(s):

High Speed ◽

Thoracic Trauma ◽

Ct Images ◽

Initial Diagnosis ◽

Cardiac Herniation ◽

Blunt Force ◽

Pericardial Rupture ◽

Ct Analysis

Pericardial rupture, with associated cardiac herniation, is generally fatal. Diagnosis is difficult and frequently missed due to the subtlety of identifying characteristics. We report a case of a left sided pericardial rupture and cardiac herniation resulting from a high speed motorcycle collision. This report describes the course of treatment from the emergent admission to the diagnosis of the pericardial tear to retrospective CT analysis and rupture identification. In addition the difficulties of initial diagnosis, key symptoms, and identification of CT images are presented and discussed.

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Diagnosis and incidence of cardiac injury in children with blunt thoracic trauma

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(89)80225-8 ◽

1989 ◽

Vol 24 (10) ◽

pp. 1091-1094 ◽

Cited By ~ 26

Author(s):

Jacob C. Langer ◽

Andrea L. Winthrop ◽

David E. Wesson ◽

Laura Spence ◽

Richard H. Pearl ◽

...

Keyword(s):

Thoracic Trauma ◽

Cardiac Injury ◽

Blunt Thoracic Trauma

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In-Hospital Diagnosis of Tricuspid Papillary Muscle Rupture in an Asymptomatic Patient after Blunt Chest Trauma

Case Reports in Critical Care ◽

10.1155/2019/1890640 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

C. S. Nabzdyk ◽

M. B. Tabrizi

Keyword(s):

Papillary Muscle ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Cardiac Injury ◽

Right Heart Failure ◽

Trauma Patients ◽

Papillary Muscle Rupture ◽

Successful Recovery ◽

Muscle Rupture ◽

Patients At Risk

Tricuspid papillary muscle rupture after blunt chest trauma is an infrequent injury that often remains undiagnosed until patients become symptomatic months to years after the trauma occurred. It is imperative to diagnose patients early with this condition in order to optimize chances of successful recovery and avoidance of sequelae of long-term tricuspid regurgitation such as atrial fibrillation and right heart failure. Here we describe a case of a 58-year-old man involved in a motocross accident suffering amongst other injuries extensive bilateral rib fractures, hemopneumothoraces, and asymptomatic anterior tricuspid papillary muscle rupture. In addition, a review of the literature and an approach for the workup of trauma patients at risk for blunt cardiac injury are provided.

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Cardiac Injury in Blunt Thoracic Trauma

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-196709000-00021 ◽

1967 ◽

Vol 7 (5) ◽

pp. 801-802

Author(s):

P Br??cke ◽

H Sp??ngler ◽

F Zekert

Keyword(s):

Thoracic Trauma ◽

Cardiac Injury ◽

Blunt Thoracic Trauma

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Pseudo-endocarditis secondary to ruptured posteromedial papillary muscle with anatomical variation: A Case Report

International Journal of Case Reports ◽

10.28933/ijcr-2020-11-0105 ◽

2020 ◽

pp. 179

Author(s):

Keyword(s):

Myocardial Infarction ◽

Mitral Valve ◽

Papillary Muscle ◽

Anatomical Variation ◽

Low Grade ◽

Papillary Muscle Rupture ◽

Atypical Chest Pain ◽

Anatomical Variant ◽

Muscle Rupture ◽

Mitral Valve Vegetation

Myocardial infarction is the leading cause of papillary muscle rupture. This complication occurs in up to 5% of cases post MI and although rare, it constitutes a cardiac emergency if left untreated. On this basis, a 59-year-old male presented with low-grade fever and atypical chest pain with raised inflammatory markers and troponin levels. He was treated for infective endocarditis after echocardiography revealed a mass on the mitral valve, which was presumed to be a mitral valve vegetation and so he completed a 6-weeks course of antibiotics followed by elective mitral valve replacement surgery. During surgery, it was discovered that there was no endocarditis. Instead an unusually small muscle head of one of the posteromedial papillary muscle groups had ruptured secondary to an inferior myocardial infarction. This ruptured muscle head was highly mobile and mimicked a mitral valve vegetation. The mitral valve was successfully repaired, and the right coronary artery grafted. He made a full recovery but developed new-onset atrial fibrillation for which he is awaiting elective cardioversion. One should have a high index of suspicion for diagnosing papillary muscle rupture as it may mimic valvular vegetation on echocardiography, especially if the papillary muscle involved is an anatomical variant.

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