Journal
ANNALS OF THORACIC AND CARDIOVASCULAR SURGERY
Volume 22, Issue 1, Pages 49-51Publisher
MEDICAL TRIBUNE INC
DOI: 10.5761/atcs.cr.15-00142
Keywords
chest trauma; pericardial rupture; surgery
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A 62-yr-old man was transferred to our institution with blunt chest trauma after being pinched between a car and a wall. Chest computed tomography revealed left-sided rib fractures, bilateral pneumothorax, and pneumopericardium, but no displacement of the heart. The pneumopericardium caused us to suspect a tear in the pericardium. Since the left pneumothorax was slightly more marked than the right, we planned a left-sided thoracoscopic exploration. As a result, a right-sided pericardial rupture was found and repaired under thoracotomy. It was difficult to judge the injured side of the pericardial tear. We learned a valuable lesson from this case: The extent of pleural air may be, but is not always, reliable for identification of the injured side of a pericardial rupture. Direct observation of the pleural space using a thoracoscope is necessary for definitive diagnosis.
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