Coexistence of Late Diagnosed Pericardial and Diaphragmatic Ruptures Caused by Rib Fracture: Case Report

INTRODUCTION: While rib fractures due to blunt traumas are common, pericardial and diaphragmatic injuries caused by rib fractures are rarely seen. Diagnosis is challenging due to the difference in clinical symptoms which may have severe clinical consequences. CASE: A 58-year-old female patient who had a traffic accident was referred to our centre due to left pericardial effusion while being followed up for tibial fracture. Left diaphragmatic rupture was detected in the radiographs taken. Intraoperative pericardial rupture was observed in the operated patient. The defects were repaired primarily and the patient was discharged in good health. CONCLUSION: Although the diagnosis is difficult In multitraumas including thoracic trauma, especially in cases with multiple rib fractures, one should be more attentive considering the possibility of diaphragmic and pericardial ruptures.

Keywords:

Pericard rupture diahragm rupture, rib fracture,

PDF

___

1.Yong-Yong W, Zhong-Liang H, Zi-Ying L. Thoracoscopic diagnosis of traumatic pericardial rupture with cardiac hernia: A case report. World J Clin Cases 2021 6; 9(16): 4001-4006.
2.Hongbin W, Min L. Blunt Traumatic Pericardial Rupture Case Report and Literature Review. Surgical Science 2013;04(10):438-442.
3.Azhar H, Ian H. Acute Diaphragmatic Injuries Associated with Traumatic Rib Fractures: Experiences of a Major Trauma Centre and the Importance of Intra-Pleural Assessment. J Chest Surg. 2021;54(1):59-64
4.Cook F, Mounier R, Martin M, Dhonneur G. Late diagnosis of post-traumatic ruptured pericardium with cardiac herniation. Can J Anaesth 2017;64: 94-95.
5.Kamiyoshihara M, Igai H, Kawatani N, Ibe T. Right or Left Traumatic Pericardial Rupture: Report of a Thought-Provoking Case. Ann Thorac Cardiovasc Surg 2016;22: 49-51.
6.M. G. Gallego, M. J. Lopez-Cambra, M. J. Fernandez. at al. Traumatic Rupture of the Pericardium. Case Report and Literature Review. Journal of Cardiovascular Surgery 1996; 37:187-191.
7. Tevrat Ö, Mustafa K, Yaşar S, Abdülkadir Ç, Siraç A, Mithat F, Cevdet T. Blunt Diaphragmatic Injuries: Pericardial Ruptures. Indian J Surg 2017;79(3):212–218.
8.Gooseman MR, Rawashdeh M, Mattam K, Rao JN, Vaughan PR, Edwards JG. Unifying classification for transdiaphragmatic intercostal hernia and other costal margin injuries. Eur J Cardiothorac Surg. 2019;01;56(1):150-158.
9.Lim KH, Park J. Blunt traumatic diaphragmatic rupture: single-center experience with 38 patients. Medicine (Baltimore) 2018;97: e12849.
10. Beng Leong L, Li Tserng T, Ming Terk C, Marxengel L A.T, Eillyne S. Traumatic diaphragmatic injuries: a retrospective review of a 12-year experience at a tertiary trauma centre. Singapore Med J. 2017;58(10): 595–600.