|Year : 2016 | Volume
| Issue : 1 | Page : 19-20
Silent Cardiac Wound
Bruno José da Costa Medeiros
Surgery Institute of Amazonas State, Rubis Street, zip code: 69053610, Manaus -AM, Brazil
|Date of Web Publication||15-Nov-2016|
Bruno José da Costa Medeiros
Surgery Institute of Amazonas State, Rubis Street, zip code: 69053610, Manaus -AM
Source of Support: None, Conflict of Interest: None
A 27-year-old male had a stab wound on the anterior chest. The patient was hemodynamically stable. Vital signs were normal in the beginning. Breath and cardiac sounds were normal. Chest X-ray revealed no signs of hemothorax or pneumothorax. Focused Assessment Sonography for Trauma (FAST) was negative. Reevaluated after 2 h, he continued apparently stable, and only his blood pressure was a little lower 100 × 60 mmHg. Second FAST was positive. He had a punctate ventricular lesion, corrected with horizontal suture. We reinforce the importance of reevaluation of the patient and systematically do the FAST or pericardial window in patients with suspected cardiac lesion.
Keywords: Cardiac wound, punctate lesion, stab wound, ventricular lesion
|How to cite this article:|
da Costa Medeiros BJ. Silent Cardiac Wound. J Cardiothorac Trauma 2016;1:19-20
| Introduction|| |
A 27-year-old male came to the hospital in Manaus-AM periphery, with a stab wound on the anterior chest, precordial region, 8 th intercostal space, and right lateral border of the sternum [Figure 1]. The patient was hemodynamically stable with vital signs: Heart rate was 82, breath rate was 18/min, blood pressure was 110 × 60 mmHg, and oxygen saturation was 98% ambient air. Breath and cardiac sounds were normal. Chest X-ray revealed no signs of hemothorax or pneumothorax, and cardiac area was normal [Figure 2]; Focused Assessment Sonography for Trauma (FAST) was negative. The Physiologic Index of the patient was 5 - stable (Ivatury, et al 1987).  The patient based on initial examinations wanted to go home. However, he remained under clinical observation according to ATLS protocol (ATLS, 2014).  He was reevaluated after 2 h, he continued apparently stable, and only his blood pressure was a little lower 100 × 60 mmHg. Another FAST was performed as showed in the picture by this time positive FAST with fluid in pericardial sac [Figure 3]. The patient went to the operating room, and a left thoracotomy with partial transverse sternotomy with control of internal mammary artery was performed [Figure 4]. The pericardial sac was opened longitudinal, and 100 ml of blood was found in the pericardial sac. We also found only a punctate lesion on the right ventricle, corrected with a horizontal suture [Figure 5]. Pericardial sac was cleaned with warm saline solution and left open. A chest tube was placed in the pleural space. The patient after surgery went to the Intensive Care Unit and is doing well. He remained stable during the whole operation. In Manaus-AM, Brazil, it is a very common stab wound on the chest; there are also five cases described of constrictive pericarditis following stab wound to the chest in stable patients that were released to home (Westphal, et al, 2000).  We reinforce the importance of FAST or pericardial window in places that there is no ultrasound patients stable with suspected cardiac lesion.
|Figure 3: Focused Assessment Sonography for Trauma positive with fluid in pericardial sac|
Click here to view
|Figure 5: Punctate lesion of the right ventricle corrected with horizontal suture|
Click here to view
This case was wrote based on the observation of a patient with stab wound on the chest, assisted by general surgery of Surgery Institute of Amazonas State on a Hospital of Periphery of Manaus-AM, Brazil.
| Conclusion|| |
Stab wound in stable patient is very difficult to manage. The patient with initial normal examinations (physical and images) is tending to go home but must remain under clinical observation and be reevaluated. The patient with a small cardiac wound on the right side tend to bleed a little and stop bleeding; if only a small amount of blood leak to the pericardial sac, the patient must remain well.
These patients must be undergone to FAST examinations or pericardial window in places that there is no ultrasound.
This kind of conduction is to prevent constrictive pericarditis or rebleeding at home and a bad end.
Therefore, Silent Cardiac Wound occurs in patients with small lesion on the heart, that initially bleed a little, but must rebleed at home and have a late tamponade or have a constrictive pericarditis. So this confirm that there is no conservative conduction on cardiac lesion, all of than must be systematically searched and surgically treated.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ivatury RR, Nallathambi MN, Rohman M, Stahl WM. Penetrating cardiac trauma. Quantifying the severity of anatomic and physiologic injury. Ann Surg 1987;205:61-6.
Committee on Trauma. Initial assessment and management. In: Advanced Trauma Life Support. 9 th
ed. Chicago: American College of Surgeons; 2014.
Westphal LF, Lima LC, Jaber BA. Traumatic late cardiac tamponade: Analysis of five cases. J Pneumol 2000;26:241-4.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]