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Pericardial rupture and cardiac herniation after blunt trauma: a case diagnosed using cardiac MRI

Departments of ¹ Radiology and ² Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea

View larger version (78K): [in a new window]   Figure 1. 55-year-old man with history of road traffic accident. (a) The initial anteroposterior (AP) chest radiograph shows multiple broken ribs on both sides, pulmonary vascular congestion and pneumomediastinum. The heart shadow is enlarged mainly due to enlargement of the left ventricle. (b) On the 14th day after admission, the follow-up chest radiograph shows decreasing extent of the opacities owing to contusion and vascular congestion. However, the cardiac outline remains obliterated and there is collapse of the left lower lobe and left pleural effusion.

View larger version (48K): [in a new window]   Figure 2. Chest CT findings. (a, b) Chest CT scans show displacement of the heart and clockwise rotation of the cardiac apex. The anterior surface of the right ventricle shows a wavy and undulated contour with a focal dimpling (arrow in Figure 2b).

View larger version (117K): [in a new window]   Figure 3. Cardiac cine-MRI findings. (a) Coronal cine MRI at the diastolic and (b) systolic phases demonstrate an exaggerated up- and down-movement of the cardiac apex, separated from the left hemidiaphragm by pleural effusion, suggesting pleuropericardial rupture and cardiac herniation.