Cardiac and Vascular Trauma




Key Points





  • Blunt and penetrating trauma result in many different types of cardiac and vascular injury.



  • Blunt deceleration/acceleration traumatic injury to the thoracic aorta is the most predictable lesion.



Trauma to the heart and aorta includes blunt and penetrating trauma imparted from widely different directions, resulting in many different forms of cardiac and vascular injury.


Of all traumatic lesions to the thoracic cardiovascular system, the most predictable one is blunt deceleration/acceleration traumatic injury to the thoracic aorta, resulting in a false aneurysm-type lesion, typically of the isthmus proximal descending aorta. It may also involve the ascending aorta, the supradiaphragmatic aorta, or the innominate artery take-off ( Figs. 28-1 to 28-13 ).




Figure 28-1


The shadows of two intact bullets are seen—one in the right paralumbar region and the other in the apex of the right ventricle. The bullet in the heart was unsuspected, as the entry site was the posterior thigh. The bullet had migrated into the right heart via the deep veins of the leg to the inferior vena cava and then into the heart.



Figure 28-2


The heart size is mildly increased, and there is accentuation of both the pulmonary arterial and venous vasculature. A knife stab wound entering from the apex had resulted in a ventricular septal defect.



Figure 28-3


Blunt chest trauma resulting in bilateral pulmonary contusions and pneumothoraces (treated with bilateral chest tubes), as well as bilateral rib fractures and a flail chest.

Apr 10, 2019 | Posted by in General Surgery | Comments Off on Cardiac and Vascular Trauma
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