title: Right or Left Traumatic Pericardial Rupture: Report of a Thought-Provoking Case.
abstract: A 62-yr-old man was transferred to our institution with blunt chest trauma after being pinched between a car and a wall. Chest computed tomography revealed left-sided rib fractures, bilateral pneumothorax, and pneumopericardium, but no displacement of the heart. The pneumopericardium caused us to suspect a tear in the pericardium. Since the left pneumothorax was slightly more marked than the right, we planned a left-sided thoracoscopic exploration. As a result, a right-sided pericardial rupture was found and repaired under thoracotomy. It was difficult to judge the injured side of the pericardial tear. We learned a valuable lesson from this case: The extent of pleural air may be, but is not always, reliable for identification of the injured side of a pericardial rupture. Direct observation of the pleural space using a thoracoscope is necessary for definitive diagnosis.
authors.affiliation: Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kamiyoshihara
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Igai
authors.forename: Natsuko
authors.initials: N
authors.lastname: Kawatani
authors.forename: Takashi
authors.initials: T
authors.lastname: Ibe
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D006335:Heart Injuries / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D010496:Pericardium / Q000293:injuries* / Q000601:surgery; D011026:Pneumopericardium / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013536:Suture Techniques; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000295:instrumentation; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery