Delayed presentation of penetrating cardiac injury successfully managed in resource limited setting: A case report

Introduction and importance: Penetrating cardiac injury is rare and historically known to have very poor prognosis. Even today, 90 % of patients die before arriving to hospital. Even though patient presentations can be atypical, organized timely intervention can lead to survival.

Case report: A 21 years old arrived 5 h after stab injury to right anterior chest. He was hypotensive with a sucking wound bleeding on his right chest as well as hemothorax on the same side. Chest tube and pericardial window were both done with blood in pericardial space. Median sternotomy was done and revealed right atrial perforation. The perforation was repaired and the patient was discharged and continues to do well on follow up.

Clinical discussion: For most patients, time from injury to surgery is short. Focused and organized surveys as well as resuscitation are valuable for any patent with penetrating thoracic trauma. With a patient in hemorrhagic shock and a penetrating wound near the heart, a pericardial window is required regardless of the absence of pericardial fluid on ultrasound and in this case proved to be lifesaving. If there is a hole in the pericardium communicating with the pleural space the pericardial blood may decompress into the pleural cavity and not be visible on ultrasound.

Conclusion: Regardless of its rare prevalence, high index of suspicion for cardiac injury is extremely important in all patients with penetrating chest trauma in the cardiac box regardless of atypical presentations. With rapid diagnosis, capable surgeon availability, and availability of blood products, patients can survive this injury.