Delayed Cardiac Rupture Associated with Traumatic Asphyxia

We report a case of delayed cardiac rupture associated with traumatic asphyxia. A 61-year-old man was pinned between a diesel shovel and steel material for 30 minutes, then transferred to our hospital. In our emergency room, he was comatose and showed craniocervical cyanosis and subconjunctival petechial hemorrhage. His hemodynamic state was stable and he had no major injury to the chest or abdomen. Initial chest X-rays, echocardiography and electrocardiography showed no abnormalities apart from right second and third rib fractures. He was treated in the intensive care unit under the diagnosis of traumatic asphyxia. Twenty hours after the trauma his hemodynamic condition gradually worsened. Electrocardiography showed sinus tachycardia and low voltage QRS complex, but echocardiography demonstrated no pericardial effusion. Thirty hours after the trauma he suddenly developed shock with a systolic blood pressure of 50mmHg and tachycardia of 170beats/minute, and repeated echocardiography showed massive pericardial effusion. Pericardiocentesis produced 700ml of pure blood. Cardiac tamponade secondary to cardiac rupture was strongly suggested. Emergent median sternotomy was performed, and a tear in the right ventricle was repaired using pledgeted 2-0 polypropylene sutures. He was discharged without any sequelae after 10 days' hospitalization. This case illustrates the importance of thorough cardiac evaluation in patients with traumatic asphyxia.