Extrapericardial Cardiac Tamponade by a Mediastinal Hematoma
Cardiac tamponade may result from a variety of intraper-icardial or extrapericardial sources of compression of the heart and great vessels. Postoperative tamponade following open-heart surgery is a well-known entity caused by either hemorrhage within the pericardial sac or by mediastinal hematoma formation. Mediastinal hematoma has been reported in association with cardiac tamponade in several clinical settings, including nonaortic mediastinal hemorrhage from cervical spine fractures, aortic and carotid aneurysmal rupture, mediastinal and cardiac penetrating trauma,- performation of mediastinal structures from subclavian vein catheterization, and in one case of blunt trauma to the anterior chest wall.
Our institution is a major primary and tertiary referral center for blunt trauma, and many of these patients suffer severe blunt injury to the chest. In this paper, we present the unusual observation of an anterior mediastinal hematoma resulting from blunt chest trauma which caused extrapericardial cardiac tamponade. The diagnosis was made with the aid of conventional two-dimensional echocardiography in addition to hemodynamic parameters and roentgeno-graphic findings. Link
A 57-year-old man was involved in a head-on motor vehicle accident, sustaining multiple rib fractures, bilateral hemopneumo-thoraces, a liver fracture, and several small mesenteric avulsions. He was wearing a seat-belt with a shoulder-harness at the time of the accident which left a distinctive ecchymotic band from the left shoulder to the right iliac crest across the anterior chest wall. In addition to the shoulder harness injury, a steering-wheel chest contusion was suspected. Bilateral chest tubes were placed to decompress the hemopneumothoraces, and oral intubation was required with mechanical ventilation for respiratory support. A subsequent chest roentgenogram revealed a widened mediastinum with a blunted cardiac apex consistent with mediastinal hematoma (Fig 1).
Figure 1. Anteroposterior chest roentgenogram demonstrating a widened mediastinum and enhanced tracheal and bronchial air shadows suggestive of a mediastinal hematoma.