title: Penetrating cardiac injury and the significance of chest computed tomography findings.
abstract: In rare circumstances, hemodynamically stable patients can harbor serious penetrating cardiac injuries. We hypothesized that chest computed tomography (CCT) is potentially useful in evaluation. The records of all patients admitted to our center with wounds to the precordium or who sustained a hemothorax or pneumothorax after penetrating torso injuries over a 48-month period were reviewed. Those having an admission CCT were studied. The potential diagnostic value of hemopericardium (HPC) and pneumopericardium (PPC) on CCT was examined. Most of the 333 patients were male [293 (88.0 %)] with a roughly equal distribution of gunshot [189 (56.8 %)] and stab [144 (43.2 %)] wounds. Mean age was 28.7 ± 12.6 years. Thirteen (3.9 %) patients had cardiac injuries that were operatively managed. Eleven (3.3 %) CCT studies demonstrated HPC and/or PPC. Ten of these patients had an injury with one false positive. Retained hemothorax and proximity findings on the three false negative CCT studies led to video-assisted thoracoscopic surgery or subxiphoid exploration with diagnosis of the injury. HPC and/or PPC on CCT had a sensitivity of 76.9 %, specificity of 99.7 %, positive predictive value of 90.9 %, and negative predictive value (NPV) of 99.1 % for cardiac injuries. However, including all findings that changed management, CCT had a sensitivity and NPV of 100 %. CCT is a potentially useful modality for the evaluation of cardiac injuries in high-risk stable patients. The presence of HPC and/or PPC on CCT after penetrating thoracic trauma is highly indicative of a significant cardiac injury.
authors.affiliation: Division of Trauma/ Acute Care Surgery/ Surgical Critical Care, Harbor-UCLA Medical Center, 1000 W. Carson St., Box 42, Torrance, CA 90502, USA. dsplurad@yahoo.com
authors.forename: David S
authors.initials: DS
authors.lastname: Plurad
authors.forename: Scott
authors.initials: S
authors.lastname: Bricker
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Van Natta
authors.forename: Angela
authors.initials: A
authors.lastname: Neville
authors.forename: Dennis
authors.initials: D
authors.lastname: Kim
authors.forename: Frederic
authors.initials: F
authors.lastname: Bongard
authors.forename: Brant
authors.initials: B
authors.lastname: Putnam
mesh_terms: D000328:Adult; D005260:Female; D006335:Heart Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D012042:Registries; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery