Hemopericardium Research Articles

Spontaneous rupture of three different chambers of heart found during autopsy, a case series

Haemopericardium and death following spontaneous rupture of heart are not very uncommon. Various literatures till now have described cases of ventricular and atrial ruptures following either myocardial infarction or blunt trauma chest. This paper describes three different autopsy cases of heart wall rupture with haemopercardium, one each of left ventricular, right ventricular and left atrial ruptures.

Role of Postmortem CT in the Forensic Evaluation of Hemopericardium

Hemopericardium (HP) is defined as the accumulation of blood in the pericardial sack. In a clinical setting, prompt identification of the presence of HP is of huge importance, because HP can result in pericardial tamponade. While echocardiography remains the most appropriate method for the evaluation of pericardial effusions in the clinical setting, postmortem imaging computed tomography (PMCT) is a valuable instrument for detecting the presence of HP and in evaluating its significance in causing mechanical impairment of cardiac activity and finally death. In this article, the actual knowledge on PMCT imaging findings related to HP are reported, with particular attention to the assessment of its significance with relation to the forensic diagnosis of the cause of death. According to the present work, the diagnosis of pericardial tamponade due to HP might be considered one of the critical fields of investigation where classical autopsy may fail and where PMCT imaging may offer its most important aids.

The armored heart: Differentiating the etiology of hemopericardium on postmortem computed tomography

The armored heart: Differentiating the etiology of hemopericardium on postmortem computed tomography

Rivaroxaban and Hemopericardium – Is There an Association?

Rivaroxaban and Hemopericardium – Is There an Association?

Ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, cardiogenic shock, and death in a patient with acute ST elevation myocardial infarction during transthoracic echocardiography

The incidence of mechanical complications related to myocardial infarction has decreased due to various factors over the last few decades. Patients admitted for acute ST segment elevation myocardial infarction (STEMI) may respond well to thrombolytic therapy before being taken up for coronary angiography and percutaneous coronary intervention depending on the facilities available at the specific center. Unfortunately, some patients develop complications of myocardial infarction during hospital stay or postdischarge. We present a patient admitted with acute STEMI responding well to thrombolytic therapy. During transthoracic echocardiography of the patient in Intensive Care Unit, the patient developed ventricular septal rupture, right ventricular free wall rupture, hemopericardium, cardiac tamponade, and cardiogenic shock and expired.

EP05.01: Fetal spontaneous and isolated hemopericardium producing tamponade: case report

EP05.01: Fetal spontaneous and isolated hemopericardium producing tamponade: case report

Role of post-mortem computed tomography (PMCT) in the assessment of the challenging diagnosis of pericardial tamponade as cause of death in cases with hemopericardium.

When hemopericardium (HP) is found at autopsy, it represents a challenge for the forensic pathologist when having to assess its role in causing death. In fact, a proper diagnosis of pericardial tamponade (PT) must be based on clinical and instrumental data, which are not often available at post-mortem investigation. The aim of this study was to individuate post-mortem (PMCT) findings indicative for the diagnosis of PT. We revised PMCT images and autopsy reports of 14 cases with fatal HP and intact pericardium. From autopsy reports, we obtained volume and cause of HP. PMCT images were reviewed to describe appearance of HP and the presence of indirect signs of increased intrapericardial pressure. A control group of 11 cases submitted to PMCT prior to autopsy was selected with the following criteria: absence of relevant pericardial effusion, venous system congestion and bleeding. Of the 14 PT subjects, 13 had a double-concentric stratification of HP and compression of the coronary sinus and/or of the pulmonary trunk, all showing a flattening of the anterior surface of the heart; other findings indicative of venous system congestion were variably observed. In the control group, none of these findings was identified, with the exception of a distended or non-completely collapsed superior vena cava (11/11 cases). PMCT is able to provide some findings indicative of PT. Based on this evidence, in other instances HP could be judged circumstantial rather than fatal. This study suggests the possibility to use PMCT findings to retrospectively demonstrate a clinical condition, such as PT.

Cardiac Tamponade as a Complication of Myocardial Infarction: A Rapidly Fatal Entity

Cardiac tamponade (CT) is a clinical emergency, characterised by pressure on the heart due to accumulation of fluid in the pericardial space, which may be blood, pus or other fluids. CT impairs ventricular filling during diastole and thus reduces cardiac output. It is an important cause of sudden natural death due to cardiovascular involvement. Cardiovascular causes account for more than 45–50% cases of sudden deaths. Among the various causes of CT, rupture of acute myocardial infarction (RAMI) and rupture of dissecting ascending aortic aneurysm (RD3A) are most common. There is very scarce data in literature on the incidence of CT as a cause of death in the cases of sudden deaths, except one large study and most other case reports. Death due to CT remains unobserved in almost 50% of cases and even if observed, CT due to haemopericardium (HP) in cases of RAMI gives little time to clinician to make a correct diagnosis and treatment, leading to suspicion about cause and manner of death and many legal complications. Thus, the present study was undertaken to find out the incidence of CT in the cases of sudden death, the frequency of various causes of CT, age groups affected, its pathology and survival time. This study was conducted in the Department of Forensic Medicine & Toxicology at Indira Gandhi Medical College, Nagpur. During a period of two years, 2,759 medico-legal autopsies were performed in this department, of which in 189 cases there was sudden natural death, which were selected for the present study, of which 9 patients died due to CT. All the nine patients of CT were male. CT is the third most common cause of death due to myocardial infarction (MI) after only to rhythm disturbances and cardiogenic shock. It is most often related to HP, attributable to either RAMI or intra-pericardial RD3A, though in our study it was only RAMI.

2.8. Post-mortem CT (PMCT) imaging findings of pericardial tamponade due to hemopericardium

Objectives Hemopericardium (HP) is occasionally found at autopsy, but it represents a challenge for the forensic pathologist when having to assess its pathophysiological role in causing death, particularly in those cases where ante-mortem clinical and instrumental data are not available. The aim of this study was to individuate PMCT findings indicative for the diagnosis of pericardial tamponade (PT). Materials and methods We retrospectively revised PMCT images and autopsy reports of 14 cases with fatal HP and intact pericardium. From autopsy reports, we obtained volume and cause of HP. PMCT images were reviewed to describe: appearance of HP, presence of indirect signs of increased intrapericardial pressure. A control group of 11 cases submitted to PMCT prior to autopsy was selected with the following criteria: absence of relevant pericardial effusion, venous system congestion and bleeding. Results Of the 14 PT subjects, 13 had a double concentric stratification of HP and compression of the coronary sinus and/or of the pulmonary trunk, all showed a flattening of the anterior surface of the heart; other findings indicative of venous system congestion were variably detected. In the control group none of these findings was identified, with the exception of a distended superior vena cava equalling the ascending aorta (8/11 cases). Conclusions PMCT is able to provide some findings indicative of PT. Based on this evidence, in other instances HP could be judged circumstantial rather than fatal. This study suggests the possibility to use PMCT findings to retrospectively demonstrate an in vivo dynamic condition, such as PT.

The role of post-mortem CT (PMCT) imaging in the diagnosis of pericardial tamponade due to hemopericardium: A case report

Hemopericardium (HP) is frequently found at autopsy, but it represents a challenge for the forensic pathologist when having to assess its etiopathological relationship in causing death, particularly in those cases where ante-mortem clinical and instrumental data are not available. The diagnosis of pericardial tamponade (PT), in fact, is based on signs, symptoms and instrumental evidence and not only on the presence of HP. Post-mortem imaging techniques are actually considered a useful and non-invasive method able to enhance traditional procedures in demonstrating critical forensic findings; consequently, post-mortem imaging methods have been widely introduced in forensic investigations. We report a case of death clearly due to PT caused by ruptured dissected aneurysm of the aorta, submitted to post-mortem CT (PMCT) and PMCT angiography prior to autopsy. PMCT imaging permitted to solve the case without performing autopsy. In the paper we identify PMCT findings suggestive of PT with the aim of verifying the possibility to use post-mortem evidence to retrospectively demonstrate an in vivo dynamic clinical condition, such as PT.

Suicide Due to Four Speargun Shots

In the literature, only a few cases of deaths related to the use of atypical firearms are present and even more rare are cases of suicide due to multiple lesions.In the present case, the authors report a rare occurrence of suicide due to 4 speargun shots, 3 to the chest and 1 to the head.A complete forensic approach led to attribute the death to acute cardiac failure due to hemopericardium after the injury of the left coronary artery.Scene investigation and autoptic findings allowed authors to hypothesize that injury to the head was a last attempt of suicide, elapsed during the progression of cardiac tamponade.With this report, the authors would like to share knowledge with the forensic community about speargun-related lesions distinguishing them from the very similar ones produced by cold steels.It also shows how it is possible to survive for some time after being shot by such a weapon.

Value of minimally invasive, whole body, post-mortem CT angiography in determining causes of spontaneous haemopericardium

Introduction Whole body post-mortem CT angiography (PMCTA) is routinely used to detect bleeding sites. This presentation examines the capacity of our technique to detect the site and cause of rupture in cases of haemopericardium(HPC). Methods 360 Autopsies where the cause of death was cardiac tamponade due to non-traumatic HPC were reviewed. Candidate cases for PMCTA were detected on the preliminary CT scan. Full autopsies were performed on all cases after angiography. Results Ventricular rupture leading to HPC was described in 161/360 (45%) cases. 118/161 (73%) from the left ventricle, 3 ( Discussion Our preliminary review of autopsy reports for HPC indicate that the vast majority of ventricular rupture is on the left thus single phase PMCTA using femoral arterial infusion may be all that is required. In 84% of cases, PMCTA has performed at VIFM was able to demonstrate the site and/or cause of HPC. All aortic dissections/aneurysms were detected. Failure to demonstrate left ventricular rupture was due to poor technique. Conclusion PMCTA is effective for demonstrating sites of rupture in non-traumatic HPC.

Penetrating cardiac injury and the significance of chest computed tomography findings

In rare circumstances, hemodynamically stable patients can harbor serious penetrating cardiac injuries. We hypothesized that chest computed tomography (CCT) is potentially useful in evaluation. The records of all patients admitted to our center with wounds to the precordium or who sustained a hemothorax or pneumothorax after penetrating torso injuries over a 48-month period were reviewed. Those having an admission CCT were studied. The potential diagnostic value of hemopericardium (HPC) and pneumopericardium (PPC) on CCT was examined. Most of the 333 patients were male [293 (88.0 %)] with a roughly equal distribution of gunshot [189 (56.8 %)] and stab [144 (43.2 %)] wounds. Mean age was 28.7 ± 12.6 years. Thirteen (3.9 %) patients had cardiac injuries that were operatively managed. Eleven (3.3 %) CCT studies demonstrated HPC and/or PPC. Ten of these patients had an injury with one false positive. Retained hemothorax and proximity findings on the three false negative CCT studies led to video-assisted thoracoscopic surgery or subxiphoid exploration with diagnosis of the injury. HPC and/or PPC on CCT had a sensitivity of 76.9 %, specificity of 99.7 %, positive predictive value of 90.9 %, and negative predictive value (NPV) of 99.1 % for cardiac injuries. However, including all findings that changed management, CCT had a sensitivity and NPV of 100 %. CCT is a potentially useful modality for the evaluation of cardiac injuries in high-risk stable patients. The presence of HPC and/or PPC on CCT after penetrating thoracic trauma is highly indicative of a significant cardiac injury.

Short-and mid-term outcomes of transcatheter intervention for critical pulmonary stenosis and pulmonary atresia with intact ventricular septum in neonates

To assess the safety and efficacy of transcatheter intervention for critical pulmonary stenosis (CPS) and pulmonary atresia with intact ventricular septum (PA/IVS) in neonates. From June 2006 to September 2011, 27 neonates including CPS in 19 patients and PA/IVS in 8 patients underwent transcatheter intervention. All patients had membranous stenosis or atresia without severe Ebstein's anomaly and severe right ventricle and pulmonary valve hypoplasia, without right ventricle-dependent coronary circulation in PA/IVS. The mean age was (16.8 ± 9.9) d. The mean weight was (3.3 ± 0.5) kg. Two of them were premature neonates, the weight was 2.3 kg and 2.5 kg, respectively. The procedural success, early outcome, complication rates, midterm results and pulmonary regurgitation were retrospectively studied. Twenty-six patients were successfully treated with transcatheter intervention. Right ventricular pressure fell from (112.0 ± 21.0) mm Hg (1 mm Hg = 0.133 kPa) to (50.4 ± 15.9) mm Hg (P < 0.001). The ratio of right ventricular pressure and aortic pressure fell from 1.7 ± 0.1 to 0.7 ± 0.3 (P < 0.001). One patient died early of PA/IVS. Complication occurred in 5 patients. Hemopericardium occurred in 3 patients, tachyarrhythmia in 2 patients. Five patients needed prolonged prostaglandin E(1) infusion for 3 to 14 days because of desaturation after the procedure. No patient needed surgery in neonatal period. At a mean follow-up of (33.5 ± 18.3) months (from 6 months to 5 years), 21 patients had no further transcatheter or surgical intervention. Four patients with CPS had moderate to severe residual pulmonary stenosis after the procedure, 3 of them underwent a second balloon dilation at 3 months of follow-up, the other one was waiting for the second balloon dilation. One patient with PA/IVS was waiting for a bidirectional Glenn procedure because of chronic right ventricular failure. Mild pulmonary regurgitation occurred in 18 patients (69.2%), and moderate pulmonary regurgitation in 8 patients (30.8%). Transcatheter intervention for CPS and PA/IVS in neonates is safe and effective. It can avoid neonatal surgery. Some patients may require repeat balloon valvuloplasty in infant period. In most patients surgical or transcatheter intervention could be avoided and mild pulmonary regurgitation was the common finding in midterm follow-up.

Dying from cardiac tamponade

BackgroundTo determine the causes of cardiac tamponade (CT), focussing especially on haemopericardium (HP), as a terminal mode of death, within a 430,000 rural English population.MethodsOur hospital mortuary register and, all postmortem reports between 1995 and 2004 inclusive, were interrogated for patients dying of CT or HP. The causes of CT/HP and selected morphological characteristics were then determined.Results14,368 postmortems were performed in this period: of these, 461 patients died of CT. Three cases were due to non-haemorrhagic pericardial effusion. HP accounted for the remaining 458 cases of which, five were post-traumatic, 311 followed rupture of an acute myocardial infarction (RAMI), 138 after intra-pericardial rupture of dissecting ascending aortic aneurysms (RD3A) and four were due to miscellaneous causes.HP was more commonly due to RAMI. Men tended to die from RAMI or RD3A earlier than women. RAMI or RD3A were commoner in men <70 yrs, but more frequent in women after this.Two thirds of RAMI were associated with coronary artery thrombosis. Anterior free wall rupture was commonest overall, and in women, but posterior free wall rupture was commoner in men.The volume of intrapericardial blood in RAMI (mean = 440 ml) and RD3A (mean = 498 ml) varied between 150 and 1000 ml: intrapericardial blood volume was greater in men than in women dying from either RAMI or RD3A.ConclusionAt postmortem, CT is most often related to HP, attributable to either RAMI or intrapericardial RD3A. Post-traumatic and other causes of CT are infrequent.

Seasonal variation in mortality from myocardial infarction and haemopericardium. A postmortem study

Background: Seasonal variation in the incidence of and mortality from myocardial infarction (MI) has been well recognised for many years. Haemopericardium (HP) is usually a fatal complication of MI. No...

Safety of Post-operative Intra-arterial Thrombolysis

112 Objectives Limited systemic fibrinolysis and reduced dosage are features of intra-arterial thrombolyis (IAT) that may be advantageous in the treatment of post-operative (post-op) strokes. However, IAT may increase the risk of surgical bleeding. We sought to determine the safety of post-op IAT. Methods Retrospective case series from 6 university hospitals. All cases of IAT within 2 weeks of surgery were identified. Demographics, stroke mechanism, stroke severity, imaging and angiographic findings, time between surgery and lysis, thrombolytic agent used, surgical site bleeding, intracranial bleeding, and mortality were determined. Death or complications directly related to IAT were determined. Results 35 patients (median age 72 y; range 48–85)were identified. Median time from surgery to stroke was 21 h (range 1–120). Open heart surgery was done in 18 (51%), carotid endarterectomy 6 (17%), craniotomy 3 (9%), ophthalmologic-ENT surgery 3 (9%), urologic-gynecologic surgery 2 (6%), orthopedic surgery 1 (3%), plastic surgery 1 (3%)and spinal surgery 1 (3%). The stroke causes were cardioembolism in 24 (69%), large-vessel atherosclerosis 4 (11%), dissection 3(9%), and post-endarterectomy occlusion 4 (11%). Median time to angiogram was 2.6 h (0.1–5.5).Occlusion sites were M1 in 18 (52%), M2 9 (26%), ICA 5 (14%), basilar 2 (6%)and PCA 1(3%). Thrombolysis was completed at a median of 4.5 h (range 1–7.6). TPA was used in 18 (51%) and urokinase in 17 (49%). Nine (26%) patients died. Surgical site bleeding occurred in 9 (26%) cases (minor in 6, major in 3).The major surgical bleeds were 2 post-craniectomy intracranial hemorrhages and 1 hemopericardium post-CABG; all fatal. Six deaths were non-IAT related: 3 due to cerebral edema and 3 from systemic causes. Major bleeding complications were significantly more common among patients with craniotomy (p Conclusions Post-op IAT carries a risk of bleeding in up to 26% of patients but is usually minor surgical site bleeding. Avoiding IAT in intracranial surgery patients may reduce complications. Mortality in this series was similar to that reported in prior IAT trials. IAT remains a viable therapeutic option for post-op strokes.

Süt Çocuğunda Hemoperikardiyuma Yol Açan Künt Göğüs Travması: Bir Olgu Bildirimi

A case of hemopericardium in an undernourished seven month old boy with rickets is reported History revealed no major trauma The possible cause of hemopericardium was the falling down from a bed 75 cm high two weeks before admission Coagulation tests were all normal By pericardiotomy 100 ml of blood was drained He was well during a follow up period of eight months Key words: Blunt Chest Trauma Hemopericardium Rickets

A case of haemopericardium in the dog.

A case of haemopericardium in the dog.

STAB WOUND OF THE HEART WITH DELAYED HEMOPERICARDIUM

STAB WOUND OF THE HEART WITH DELAYED HEMOPERICARDIUM