title: A concealed atriopleural fistula resulting from a cardiac stab wound.
abstract: A young male presented with a right parasternal stab wound. The chest radiography was normal and transthoracic echocardiography ruled out pericardial tamponade. He remained hemodynamically stable until three hours later when signs of progressive anemia were observed. Chest computed tomography showed massive right-sided hemothorax. The patient underwent surgery, which revealed an active bleeding atriopleural fistula connecting the right atrium and draining into the right pleura resulting from the negative pressure generated during respiration. This mechanism prevented cardiac tamponade and maintained initial hemodynamically stability.
authors.affiliation: Cardiac Surgery Department, University Hospital of Salamanca, Salamanca, Spain. Electronic address: elearnaiz@hotmail.com.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Arnáiz-García
authors.affiliation: Radiology Department, University Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Arnáiz
authors.affiliation: Cardiac Surgery Department, University Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Pontón
authors.affiliation: Cardiac Surgery Department, University Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Ivana
authors.initials: I
authors.lastname: Pulitani
authors.affiliation: Cardiac Surgery Department, University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Jose María
authors.initials: JM
authors.lastname: González-Santos
authors.affiliation: Cardiac Surgery Department, University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Arévalo-Abascal
authors.affiliation: Cardiac Surgery Department, University Hospital of Salamanca, Salamanca, Spain.
authors.forename: María E
authors.initials: ME
authors.lastname: Bueno-Codoñer
authors.affiliation: Infectious Diseases Unit, Internal Medicine Department, University Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Arnáiz-García
mesh_terms: D000328:Adult; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D006335:Heart Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D014950:Wounds, Penetrating / Q000150:complications* / Q000000981:diagnostic imaging
keywords: Atriopleural fistula; Cirurgia; Facada cardíaca; Fístula atrio-pleural/aurículo pleural; Stab wound; Surgery; Tratamento; Treatment