Traumatic right pericardial laceration with tension pneumopericardium associated with hemodynamic instability: A case report
An unconscious 44-year-old male patient was brought to the emergency department of our hospital due to falling from a height. The first physical examination revealed a poor general medical condition with a blood pressure of 70/40 mmHg and pulse of 138/minute. Cardiac friction rub and deep cardiac sounds were heard upon the auscultation of the thorax. Computed tomography (CT) of the thorax revealed pneumothorax in the right hemithorax, subcutaneous emphysema (), and massive pneumopericardium (). The polytraumatized patient underwent an urgent operation since his hemodynamic status was deteriorating. Upon anterolateral thoracotomy through the right sixth intercostal space, a vertical laceration of 10 cm length on the pericardium, close to the superior vena cava and right atrium, and anterior to the phrenic nerve, and a 5 cm parenchymal laceration at the right lung medium lobe lateral segment were observed. The pericardial laceration was lengthened through the apex of the heart for cardiac exploration and no cardiac rupture, contusion, hemorrhage, and additional pericardial laceration was identified. Thus, the laceration was repaired with an approximation suture, placing a 32F thorax drain. Parenchymal defect at the medium lobe of the right lung was primarily repaired by a thoracic surgeon. Tissue layers were closed appropriately with placement of a 32F thoracic drain in the right hemithoracic space, since no bleeding, air leak, or diaphragm pathology was seen. The polytraumatized patient was operated on by orthopedic surgeons for pelvic and right femur neck fractures, and by general surgeons due to intra-abdominal bleeding with intensive blood and blood product transfusion on the same session. Blood pressure was 100/60 mmHg with a pulse rate of 90/min. In the early postoperative period under cardiac supportive therapy, disseminated intravascular coagulopathy (DIC) developed and the patient died, in spite of all supportive therapy, 40 hours after surgery.