Role of echocardiography in the diagnosis of occult penetrating cardiac injury.
OBJECTIVE
To determine the usefulness of early echocardiography in stable patients with penetrating wounds in proximity to the heart.


METHODS
Retrospective chart review over a 1-year period.


METHODS
Urban level I trauma center.


METHODS
121 clinically stable patients with penetrating wounds in proximity to the heart underwent immediate echocardiography (ECHO). Those with evidence of pericardial effusion then underwent subxiphoid pericardial window (SPW), followed by a median sternotomy if blood was found.


RESULTS
Thirty patients had an ECHO that was positive and underwent immediate SPW. One patient with an initially negative ECHO deteriorated 5 hours after admission; a repeat ECHO was positive, and he also underwent SPW. In 16 of the 31 SPW performed, blood in the pericardial sac was confirmed. Of these 16, four had pericardial blood that cleared with irrigation and required no further intervention. The remaining 12 patients underwent exploration: 3 had injury to the pericardium only, 4 had injury to the right atrium, 3 had injury to the right ventricle, and 2 had injury to the left ventricle. All nine myocardial injuries required operative repair; all survived.


CONCLUSIONS
Using the protocol of early ECHO and selective pericardial window, no clinically significant injuries were missed. In all, 12 penetrating cardiac injuries were identified and repaired successfully. We have found early and aggressive work-up, as outlined herein, to be helpful in the successful treatment of occult cardiac injuries.
Nagy
K K
KK
Department of Trauma, Cook County Hospital, Chicago, Illinois 60612, USA.
Lohmann
C
C
Kim
D O
DO
Barrett
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000628:therapy; D012189:Retrospective Studies; D014193:Trauma Centers; D014463:Ultrasonography; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery