J Cardiovasc Ultrasound.  2010 Mar;18(1):28-30. 10.4250/jcu.2010.18.1.28.

Delayed Diagnosis of Traumatic Ventricular Septal Defect in Penetrating Chest Injury: Small Evidence on Echocardiography Makes Big Difference

• Jeon K
• Lim WH
• Kang SH
• Cho I
• Kim KH
• Kim HK
• Kim YJ
• Sohn DW

• KMID: 1457203
• DOI: http://doi.org/10.4250/jcu.2010.18.1.28

Abstract

Cardiac trauma from penetrating chest injury is a life-threatening condition. It was reported that < 10% of patients arrives at the emergency department alive. Penetrating chest injury can cause serious damage in more than 1 cardiac structure, including myocardial lacerations, ventricular septal defect (VSD), fistula between aorta and right cardiac chamber and valves. The presence of pericardial effusion (even a small amount) on the initial echocardiography might be the only clue to serious cardiac damage in the absence of definite evidence of anatomical defect in heart. We here present a case, in which clear diagnosis of VSD and pseudoaneurysmal formation was delayed a few days after penetrating chest injury due to the lack of anatomical evidence of damage.

Keyword

Ventricular septal defect; Penetrating chest trauma

MeSH Terms

Aneurysm, False
Aorta
Delayed Diagnosis
Echocardiography
Emergencies
Fistula
Heart
Heart Septal Defects, Ventricular
Humans
Lacerations
Pericardial Effusion
Thoracic Injuries
Thorax

Figure

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  Fig. 1 Initial CT angiography reveals a small extent of low attenuation lesion at the mid anteroseptal myocardium (arrow).

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  Fig. 2 Follow up CT angiography performed at 3 days after injury. Short axis plane (A) and coronal plane (B) shows traumatic ventricular septal defect (VSD) at left ventricular mid-anteroseptal wall (arrow). LV: left ventricle, RV: right ventricle.

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  Fig. 3 Follow up echocardiography showing traumatic ventricular septal defect (VSD). Parasternal short axis view (A) shows the VSD at the basal to mid junction of anteroseptum (arrow) and a Doppler image (B) reveals mitral flow variation according to respiratory cycle, suggestive of constrictive physiology. LV: left ventricle, RV: right ventricle.

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  Fig. 4 Cardiac magnetic resonance image for preoperative evaluation. Cardiac MRI shows traumatic ventricular septal defect (VSD) in the mid-anterior septal wall (arrow).

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