Penetrating heart injury in a case with pericardial adhesions

Abstract

A 30-year-old male who was admitted to emergency department due to cutting and penetrating stab wounds had a 2 cm stab wound at the intersection of the right midclavicular line and 6th i ntercostals s pace. T here w as n o s ignificant finding on chest X-ray and echocardiography. Computed tomography (CT) which was performed to eliminate any other thoracic or mediastinal injury revealed a passage of contrast material from the right ventricle to the retrosternal space. The patient underwent median sternotomy urgently. After adhesions were removed in the patient with hematoma and pericardial adhesions, a 5 cm laceration along the sharp margin of the right ventricle was seen. The injury was repaired primarily with pledgeted 4/0 polypropylene sutures. The patient recovered without any complication. It was found that the patient with a history of familial Mediterranean fever (FMF) had asymptomatic pericarditis. Pericardial adhesions due to previous pericarditis limited severe cardiac injury by masking the echocardiographic findings. Echocardiography may not solely establish the extent of the involvement of cardiac chambers secondary to cutting and penetrating stab wounds towards the heart. In case of any clinical suspicion, CT contributes to the definitive diagnosis.