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Acute Cardiac Injury - Airbags Are Not Innocuous
Description
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A3441 - Acute Cardiac Injury - Airbags Are Not Innocuous
Author Block: T. Kukkadapu1, J. Godsell1, S. Taylor2, V. Patel1, G. Sharma3, J. Keshavamurthy2; 1Augusta University, Augusta, GA, United States, 2Radiology, Augusta University, Augusta, GA, United States, 3Cardiology, Augusta University, Augusta, GA, United States.
Introduction
Cardiac valvular injury is an unusual but potentially life threatening cardiac injury following chest trauma. We present a case of tricuspid valvular injury secondary to airbag deployment.
Case Description
A 20-year-old male presented to the emergency department (ED) with chest pain following a motor vehicle collision with airbag deployment. Chest CT showed pneumopericardium and large right pneumothorax. Transthroracic echocardiogram (TTE) showed tachycardia but normal biventricular function without effusion or tamponade. No tricuspid valve injury was detected due to a poor window, and there was no suspicion for valvular injury. The patient was admitted and monitored for hemodynamic instability.
Seven days after presentation, as the patient was resuming ambulation, repeat TTE demonstrated normal left ventricular function, a small pericardial effusion, and no tamponade; however, there was severe tricuspid regurgitation and possible flail leaflet. Transesophageal echocardiogram (TEE) confirmed severe tricuspid regurgitation with valve injury with mild enlargement of the right ventricle and atrium, but preserved right ventricular function. He was hemodynamically stable although tachycardic and hypervolemic. He was managed medically and discharged.
One day later the patient presented to the ED with dyspnea. Chest CT showed new bilateral pleural and pericardial effusions, which were hypodense suggesting fluid density rather than blood. The patient underwent emergent pericardial window and placement of bilateral chest tubes. Over the next few days the patient was diuresed and the chest tubes were removed. Repeat TEE demonstrated enlargement of the right atrial and ventricular size with preserved right ventricular function. The patient was discharged after a few days.
At follow up a few days later, the patient had continued tachycardia but was hemodynamically stable and euvolemic. TTE demonstrated normal right ventricular function with mild enlargement of the right atrium and ventricle with severe tricuspid regurgitation and no effusion. At follow-up 1 month later, patient was doing well with normal heart rate and no edema.
Discussion
There should be high clinical suspicion for traumatic cardiac injury following severe chest trauma. The presence of pneumopericardium should prompt continued cardiac surveillance for initially occult injury. Tricuspid valve injury should still be suspected even if no clinical signs are present, particularly in patients with multiple organ injuries or significant chest trauma as presentation may be delayed. Causes of valvular injury include rupture of the chordae tendineae, papillary muscles, or valve leaflets. Younger patients may be more at risk for blunt trauma to the right heart due to incompletely fused thoracic cartilage.
Author Block: T. Kukkadapu1, J. Godsell1, S. Taylor2, V. Patel1, G. Sharma3, J. Keshavamurthy2; 1Augusta University, Augusta, GA, United States, 2Radiology, Augusta University, Augusta, GA, United States, 3Cardiology, Augusta University, Augusta, GA, United States.
Introduction
Cardiac valvular injury is an unusual but potentially life threatening cardiac injury following chest trauma. We present a case of tricuspid valvular injury secondary to airbag deployment.
Case Description
A 20-year-old male presented to the emergency department (ED) with chest pain following a motor vehicle collision with airbag deployment. Chest CT showed pneumopericardium and large right pneumothorax. Transthroracic echocardiogram (TTE) showed tachycardia but normal biventricular function without effusion or tamponade. No tricuspid valve injury was detected due to a poor window, and there was no suspicion for valvular injury. The patient was admitted and monitored for hemodynamic instability.
Seven days after presentation, as the patient was resuming ambulation, repeat TTE demonstrated normal left ventricular function, a small pericardial effusion, and no tamponade; however, there was severe tricuspid regurgitation and possible flail leaflet. Transesophageal echocardiogram (TEE) confirmed severe tricuspid regurgitation with valve injury with mild enlargement of the right ventricle and atrium, but preserved right ventricular function. He was hemodynamically stable although tachycardic and hypervolemic. He was managed medically and discharged.
One day later the patient presented to the ED with dyspnea. Chest CT showed new bilateral pleural and pericardial effusions, which were hypodense suggesting fluid density rather than blood. The patient underwent emergent pericardial window and placement of bilateral chest tubes. Over the next few days the patient was diuresed and the chest tubes were removed. Repeat TEE demonstrated enlargement of the right atrial and ventricular size with preserved right ventricular function. The patient was discharged after a few days.
At follow up a few days later, the patient had continued tachycardia but was hemodynamically stable and euvolemic. TTE demonstrated normal right ventricular function with mild enlargement of the right atrium and ventricle with severe tricuspid regurgitation and no effusion. At follow-up 1 month later, patient was doing well with normal heart rate and no edema.
Discussion
There should be high clinical suspicion for traumatic cardiac injury following severe chest trauma. The presence of pneumopericardium should prompt continued cardiac surveillance for initially occult injury. Tricuspid valve injury should still be suspected even if no clinical signs are present, particularly in patients with multiple organ injuries or significant chest trauma as presentation may be delayed. Causes of valvular injury include rupture of the chordae tendineae, papillary muscles, or valve leaflets. Younger patients may be more at risk for blunt trauma to the right heart due to incompletely fused thoracic cartilage.
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