Traumatic pericardial rupture with skeletonized phrenic nerve.
BACKGROUND
Traumatic pericardial rupture is a rare presentation. Pericardial rupture itself is asymptomatic unless complicated by either hemorrhage or herniation of the heart through the defect. Following diagnosis surgical repair of the pericardium is indicated because cardiac herniation may result in vascular collapse and sudden death.


OBJECTIVE
Here we present a case of traumatic, non-herniated pericardial rupture with complete skeletonization of the phrenic nerve.


METHODS
An 18-year-old healthy male suffered multi-trauma after falling 50 feet onto concrete. The patient could not be stabilized despite exploratory laparotomy with splenectomy, IR embolization and packing for a liver laceration. Right posterolateral thoracotomy revealed a ruptured pericardium with a completely skeletonized phrenic nerve. The pericardium was repaired with a Goretex(R) patch.


CONCLUSIONS
A high level of suspicion for pericardial rupture is necessary in all patients with high-velocity thoracic injuries.
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. zkhalpey@partners.org
Zain
Z
Khalpey
Taufiek K
TK
Rajab
Jan D
JD
Schmitto
Philipp C
PC
Camp
D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006335:Heart Injuries / Q000175:diagnosis*; D006801:Humans; D008297:Male; D010496:Pericardium / Q000293:injuries / Q000294:innervation*; D010791:Phrenic Nerve / Q000293:injuries* / Q000601:surgery; D012421:Rupture; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000601:surgery
Circulation. 1958 Sep;18(3):371-96
13573559
J Cardiovasc Surg (Torino). 1990 Jul-Aug;31(4):525-30
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