Blunt Thoracic Trauma-Induced Mitral Papillary Muscle Avulsion with Pericardial Rupture and Cardiac Herniation: Difficult and Delayed Diagnoses

Ross Mccauley,Michael Steinberg,Faisal Shariff,Patrick Davis,Mark Thompson,Thomas B Bemenderfer,Edward Evans,Christopher Lesh,Mark Walsh

doi:10.1155/2020/3268253

Abstract

Blunt thoracic trauma (BTT) and the resultant isolated mitral papillary muscle avulsion, pericardial rupture, and cardiac herniation injuries are each rarely diagnosed clinical entities. We describe the first case of combined pericardial tear with cardiac herniation and ruptured mitral papillary muscles following BTT. Preoperative transesophageal echocardiography (TEE) diagnosed the delayed mitral papillary muscle rupture while all previous diagnostic modalities failed to delineate the pericardial rupture and cardiac herniation. Particular emphasis is placed on the clinical and radiologic aspects of the case that would heighten clinical suspicion in the emergency setting where blunt cardiac injury sequelae are suspected and frequently missed.

Highlights

Blunt thoracic trauma (BTT) is a primary cause of morbidity, mortality, hospitalization, and disability in the United States and is the major contributing factor in over a quarter of all trauma-related deaths [1, 2]
BTT can result in a variety of cardiac injuries, ranging from minor cardiac contusion to the more severe pathology such as cardiac rupture, pericardial rupture, cardiac herniation, valvular injury, myocardial infarction, or arrhythmia [1,2,3]
We present the literature’s first case of combined mitral papillary muscle avulsion, pericardial rupture, and cardiac herniation and propose findings that, in retrospect, may expedite diagnosis

Summary

Introduction

Blunt thoracic trauma (BTT) is a primary cause of morbidity, mortality, hospitalization, and disability in the United States and is the major contributing factor in over a quarter of all trauma-related deaths [1, 2]. BTT can result in a variety of cardiac injuries, ranging from minor cardiac contusion to the more severe pathology such as cardiac rupture, pericardial rupture, cardiac herniation, valvular injury, myocardial infarction, or arrhythmia [1,2,3]. BTT-associated mitral valve injury, pericardial rupture, and cardiac herniation are independently very rare clinical entities with high mortalities and have not been reported together in the literature. We discuss the protean nature of the presentation of pericardial rupture with cardiac herniation where the diagnosis is often made retrospectively and intraoperatively. We present the literature’s first case of combined mitral papillary muscle avulsion, pericardial rupture, and cardiac herniation and propose findings that, in retrospect, may expedite diagnosis

Case Report

Findings

Discussion

Conclusion