Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Life-Threatening Delayed Pericardial Tamponade Following Blunt Chest Trauma Brian Musch, DO 1 ; Rachel Daley, OMS-III 2 , Saptarshi Biswas, MD, FACS 1

1. Grand Strand Medical Center, Dept. of Surgery, Myrtle Beach, SC. 2. Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg, SC.

Background

Case Report Cont.

Case Report Cont.

Hospital Day 15

• A 33-year-old male presented post-MVA with multisystem trauma, including: • Hemoperitoneum with grade V splenic laceration • Multiple rib fractures from ribs 2 to 11 with a flail segment and left-sided pneumothorax • Closed fractures of the sacrum, pubic ramus, and acetabulum • The patient underwent an emergent splenectomy, ICU resuscitation, and chest wall reconstruction • Pericardial tamponade is a life-threatening emergency caused by fluid accumulation in the pericardial sac, rapidly impairing cardiac function • Delay in recognition is fatal- while commonly associated with penetrating chest trauma, delayed cases after blunt trauma are rare but critical to recognize • This case emphasizes the need for immediate recognition and intervention to prevent mortality from delayed complications in trauma patients Case Report

• The patient was in a step-down unit, became tachycardic and hypotensive, and reported acute chest discomfort and dyspnea • CT revealed significant pericardial effusion, and ECHO confirmed tamponade physiology

Figure 6. Postoperative ultrasound of the pleural space following IR drainage

Figure 5. Pre-operative ultrasound of the pleural space with color doppler

Discussion

References • Davey, S., Alam , F., & Malik, S. “A Delayed Presentation of Cardiac Tamponade After Blunt Trauma.” Journal of Surgical Case Reports, vol. 20 11, no. 9, 2011, doi:10.1093/jscr/2011.9.1. • Hermens , J. A., et al. “Delayed Cardiac Tamponade in a Patient with Previous Minor Blunt Chest Trauma.” International Journal of Car diology, vol. 131, no. 3, 2009, pp. e124 – e126, doi:10.1016/j.ijcard.2007.07.080. • Matthia, E., Altshuler , E., & Naik, D. K. “Delayed Presentation of Pericardial Tamponade Following Blunt Chest Trauma.” BMJ Case Reports, vol. 14, no. 3, 2021, e240317, doi:10.1136/bcr-2020-240317. • Pendleton, A. C., & Leichtle , S. W. “Cardiac Tamponade From Blunt Trauma.” The American Surgeon, vol. 88, no. 6, 2022, pp. 1319– 1321, doi:10.1177/0003134820942170. • Rogers, F. B., et al. “Practice Management Guidelines for the Prevention of Venous Thromboembolism in Trauma Patients: The EA ST Practice Management Guidelines Work Group.” Journal of Trauma, vol. 53, no. 1, 2002, pp. 142– 164 This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. Acknowledgements • An immediate pericardial window provides rapid relief of hemodynamic compromise and is essential for significant effusions • Symptoms can mimic other conditions such as pulmonary embolism, myocardial infarction, and aortic dissection, leading to delayed recognition Conclusion • High index of suspicion is critical in patients with prior chest trauma presenting with hemodynamic instability and chest pain • Delayed pericardial tamponade cases emphasize the need for long-term follow-up after blunt chest trauma

Figure 3. Chest CT on admission showing no evidence of pericardial effusion

Figure 4. Chest CT 15 days after the initial trauma showing massive pericardial effusion

• Cardiothoracic surgery was consulted, open pericardial window was performed evacuating 150 mL of hemorrhagic fluid with significant hemodynamic improvement • Thoracic ultrasound showed significant blood in the pleural space, IR evacuated 850 mL of hemorrhagic fluid

Figure 1. CT of the abdomen showing splenic laceration and free fluid

Figure 2. 3D reconstruction revealing flail chest

2025 Research Recognition Day

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