Cardiac injury following penetrating chest trauma: Delayed diagnosis and successful repair

Abstract

Penetrating cardiac trauma is rare and often results in poor outcomes in the pediatric population. Clinical presentation may range from relative stability to cardiovascular collapse and arrest. We present a case of a cardiac gunshot injury in an 11 year old who was shot in the back, sustaining a through and through injury to left chest. The missile projectile penetrated the left ventricle with subsequent diaphragmatic and splenic injury. The cardiac injury was not identified on initial examination or intraoperative repair of diaphragmatic injury. After becoming unstable in the pediatric intensive care unit, a bedside thoracotomy was performed and the cardiac injury was successfully repaired. In the setting of penetrating thoracic trauma, a normal cardiac exam, echocardiography, or intraoperative findings should not eliminate the possibility of a cardiac injury. The key factor for patient survival is early diagnosis of injury and emergent intervention. Background: Penetrating cardiac trauma is rare and often results in poor outcomes in children. Clinical presentation may range from relative stability to cardiovascular collapse and arrest. Case report: We present a case of an 11-year old male who was shot in the back sustaining a through and through injury to left chest. A missile projectile penetrated the left ventricle with subsequent diaphragmatic and splenic injury. A cardiac injury was not identified during initial examination or laparoscopic repair of a diaphragmatic injury. Five hours after the initial presentation, the child became unstable in the pediatric intensive care unit, a bedside thoracotomy was performed and the cardiac injury was identified and successfully repaired. Conclusion: In the setting of penetrating thoracic trauma, a normal cardiac exam, echocardiography, or intraoperative findings should not eliminate the possibility of a cardiac injury. The key element for patient survival is early diagnosis of injury and emergent intervention.