Papillary Muscles Rupture as Delayed Sequelae of Trauma

Background : Spontaneous rupture of papillary muscle from sepsis is extremely rare. Most cases of papillary muscle ruptures are due to myocardial infarction or trauma. We describe a case of spontaneous acute papillary muscle rupture in absence of history of ischemic cardiomyopathy or blunt chest trauma. Case Report: A 42 year-old man was transferred to intensive care unit with signs and symptoms of cardiogenic shock. Past history revealed that he had met with a road traffic accident 19 months ago with fracture mid shaft of left femur. He was treated for the same and failed to have regular follow up visits. Physical examination revealed osteomyelitis at the fractured site with sinus formation and pyrexia. His general condition declined thereafter and expired due to cardiac failure few hours later. At autopsy there was rupture of antero-lateral papillary muscle of mitral valve. Microscopic section of the ruptured papillary muscle revealed formation of focal abscess with neutrophil infiltration. Conclusion: Papillary muscle ruptures are associated with significantly increased morbidity and mortality. Therefore early diagnosis is very important in providing appropriate treatment. This case emphasized the fact that delay in diagnosis and institution of appropriate antimicrobial therapy for sepsis may result in life threatening complications. Although this occurrence is uncommon, papillary muscle necrosis and subsequent rupture must be considered as cause of delayed deaths in cases of road traffic accidents with septicemia.