P115 UNEXPECTED FORMS OF CARDIAC COMPRESSION AB EXTRINSIC

Abstract

Abstract 75–year–old man with a history of atrial fibrillation and hypertension, arrived in the emergency room after car accident (car against tree) three hours after taking Rivaroxaban. After performing a chest CT scan in the emergency room (evidence of fractures of 4 ribs and the body of the sternum) he was admitted to Emergency Medicine where, two hours later, a cardiological evaluation was requested due to sudden desaturation. For the echocardiographic evidence of an image that compressed ab extrinsically the right sections of the heart with complete collapse of the right ventricle, urgent chest CT angiography was required which highlighted a gross sliding hiatal hernia with intrathoracic transposition of fat and large parts of the gastric fundus. It was decided to carry out an evaluation by colleagues in thoracic surgery to proceed with any surgical treatment of the pathology. Discussion A hiatal hernia consists of part of the stomach moving up into the chest through an opening in the diaphragm. It can be of three types: sliding, the most common, in which the hernia enters and exits the thoracic cavity. It is not a permanent condition, as the affected portion of the stomach is mobile above and below the diaphragm depending on the pressure exerted on the abdomen; it is more common in obese people; Paraesophageal hernia, in which the upper part of the stomach (bottom) is trapped in the chest cavity, to the side of the esophagus. Mixed hernia, simultaneous presence of sliding hernia and paraesophageal hernia, more rare. Prolapse of a small part of the stomach through the esophageal hiatus of the diaphragm is a fairly common condition. However, the herniation of a larger component is very rare and is often misleading. Rare cases have been described in the literature in which the herniation was associated with a tumor component (GIST) and cases resulting from abdominal surgery. It is often associated with typical symptoms of hiatal hernia in a more pronounced form (belching, abdominal bloating and heartburn); in addition, there have been reports of cardiac–like chest pain. However, it is of fundamental importance to make an early diagnosis in order to be initiated into an adequate therapeutic–surgical approach. As soon as the picture of the thoracic trauma stabilized, our patient was referred for corrective surgical therapy.