title: False negative pericardial Focused Assessment with Sonography for Trauma examination following cardiac rupture from blunt thoracic trauma: a case report.
abstract: BACKGROUND
  The Focused Assessment with Sonography for Trauma examination is an invaluable tool in the initial assessment of any injured patient. Although highly sensitive and accurate for identifying hemoperitoneum, occasional false negative results do occur in select scenarios. We present a previously unreported case of survival following blunt cardiac rupture with associated negative pericardial window due to a concurrent pericardial wall laceration.
  
  
  METHODS
  A healthy 46-year-old white woman presented to our level 1 trauma center with hemodynamic instability following a motor vehicle collision. Although her abdominal Focused Assessment with Sonography for Trauma windows were positive for fluid, her pericardial window was negative. After immediate transfer to the operating room in the setting of persistent instability, a subsequent thoracotomy identified a blunt cardiac rupture that was draining into the ipsilateral pleural space via an adjacent tear in the pericardium. The cardiac injury was controlled with digital pressure, resuscitation completed, and then repaired using standard cardiorrhaphy techniques. Following repair of her injuries (left ventricle, left atrial appendage, and liver), her postoperative course was uneventful.
  
  
  CONCLUSIONS
  Evaluation of the pericardial space using Focused Assessment with Sonography for Trauma is an important component in the initial assessment of the severely injured patient. Even in cases of blunt mechanisms however, clinicians must be wary of occasional false negative pericardial ultrasound evaluations secondary to a concomitant pericardial laceration and subsequent decompression of hemorrhage from the cardiac rupture into the ipsilateral pleural space.
authors.affiliation: McGill University, 845 Rue Sherbrooke Ouest, Montreal, Quebec, H3A 0G4, Canada. laura.baker2@mail.mcgill.ca.
authors.forename: Laura
authors.initials: L
authors.lastname: Baker
authors.affiliation: University of Calgary, Foothills Hospital, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada. Ammar.Almadani@albertahealthservices.ca.
authors.forename: Ammar
authors.initials: A
authors.lastname: Almadani
authors.affiliation: University of Calgary, Foothills Medical Center, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada. ball.chad@gmail.com.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
mesh_terms: D000063:Accidents, Traffic; D005188:False Negative Reactions; D005260:Female; D006341:Heart Rupture / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010496:Pericardium / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery