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Severe heart laceration in penetrating chest trauma: thoracoscopy as a key to diagnosis

^a Department of Surgery, Division of Thoracic and Hyperbaric Surgery, University Medical School, Graz, Austria
^b Department of Surgery, Division of Heart Surgery, University Medical School, Graz, Austria

^* Corresponding author. Tel.: +43-31-6385-3302; fax: +43-31-6385-4679
florian.tomaselli{at}uni-graz.at

A patient had attempted suicide by firing a butcher's gun into his left chest 3 cm caudal to the mammilla. Transthoracic echocardiography and CT-scan showed a discrete hematopneumothoraxbut no pericardial effusion, the cardio respiratory condition was stable. As the bolt had been aimed directly at the heart of the patient, thoracoscopy was performed to rule out cardiac trauma. Thoracoscopy showed a distinct severe contusion of the otherwise intact pericardium and a hemopericardium. Immediate thoracotomy and pericardiotomy revealed significant intrapericardial bleeding caused by an incomplete rupture of the left ventricle. The condition was successfully treated by direct reinforced suture.

Key Words: Chest trauma; Cardiac injury; Video-assisted thoracoscopy