A Fatal Case of Cardiac Contusion After Blunt Chest Injury.
Accidents, Occupational
Antigens, CD
/ metabolism
Antigens, Differentiation, Myelomonocytic
/ metabolism
Electrocardiography
Fatal Outcome
Humans
Immunohistochemistry
Macrophages
/ metabolism
Male
Middle Aged
Mitral Valve Insufficiency
/ etiology
Myocardial Contusions
/ etiology
Myocardium
/ pathology
Pericardial Effusion
/ etiology
Thoracic Injuries
/ complications
Ventricular Dysfunction, Left
/ etiology
Wounds, Nonpenetrating
/ complications
Journal
The American journal of forensic medicine and pathology
ISSN: 1533-404X
Titre abrégé: Am J Forensic Med Pathol
Pays: United States
ID NLM: 8108948
Informations de publication
Date de publication:
01 Mar 2021
01 Mar 2021
Historique:
pubmed:
1
8
2020
medline:
8
6
2021
entrez:
1
8
2020
Statut:
ppublish
Résumé
In this article, we report the autopsy findings of a 48-year-old man who sustained blunt trauma to the thorax. A medical record review revealed no history of cardiac disease. He presented to the hospital with a computed tomography-verified fracture of the left fourth and fifth ribs, and pulmonary and cardiac contusion. He was released from the hospital in stable condition at his own request 7 days later. Because of sudden deterioration, he was readmitted to the hospital the next day. Electrocardiogram detected cardiac arrhythmia on the 15th day after chest trauma. Electrocardiography detected pericardial effusion and severe mitral insufficiency resulting in left ventricular failure. Death was attributed to diffuse alveolar damage-complicating pneumonia due to cardiac contusion with mitral insufficiency occurring 25 days after hospital admission. Internal examination revealed diffuse fibrinous pericarditis, left atrial tear right above the anterior mitral valve leaflet with intrapericardial granulation tissue, and no sign of myocardial damage. Immunohistochemistry showed significantly more CD68-positive macrophages within tissue taken from the heart, a finding indicative of previous atrial and ventricular myocardial contusion. This case report demonstrates that routine hematoxylin and eosin staining may not always reveal significant myocardial damage.
Identifiants
pubmed: 32732593
pii: 00000433-202103000-00016
doi: 10.1097/PAF.0000000000000590
doi:
Substances chimiques
Antigens, CD
0
Antigens, Differentiation, Myelomonocytic
0
CD68 antigen, human
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
70-72Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflict of interest.
Références
Mason DT, Roberts WC. Isolated ventricular septal defect caused by nonpenetrating trauma to the chest. Proc (Bayl Univ Med Cent) . 2002;15:388–390.
Peter J, Kirchner A, Kuhlisch E, et al. The relevance of the detection of troponins to the forensic diagnosis of cardiac contusion. Forensic Sci Int . 2006;160:127–133.
Sybrandy KC, Cramer MJM, Burgersdijk C. Diagnosing cardiac contusion: old wisdom and new insights. Heart . 2003;89:485–489.
Kaye P, O'Sullivan I. Myocardial contusion: emergency investigation and diagnosis. Emerg Med J . 2002;19:8–10.
Ryan L, Skinner DL, Rodseth RN. Ventricular septal defect following blunt chest trauma. J Emerg Trauma Shock . 2012;5:184–187.
Tenzer ML. The spectrum of myocardial contusion: a review. J Trauma . 1985;25:620–627.
Ho SY, Cabrera JA, Sanchez-Quintana D. Left atrial anatomy revisited. Circ Arrhythm Electrophysiol . 2012;5:220–228.
Doty DB, Anderson AE, Rose EF, et al. Cardiac trauma: clinical and experimental correlations of myocardial contusion. Ann Surg . 1974;180:452–460.
Zhu BL, Fujita MQ, Quan L, et al. A sudden death due to cardiac conduction system injury from a blunt chest impact. Leg Med (Tokyo) . 1999;1:266–269.
Guan DW, Zhang XG, Zhao R, et al. Diverse morphological lesions and serious arrhythmias with hemodynamic insults occur in the early myocardial contusion due to blunt impact in dogs. Forensic Sci Int . 2007;166:49–57.
Clark TA, Corcoran FH, Baker WP, et al. Early repair of traumatic ventricular septal defect. J Thorac Cardiovasc Surg . 1974;67:121–124.
Wu JJ, Yu TJ, Wang JJ, et al. Early repair of traumatic ventricular septal defect and mitral valve regurgitation. J Trauma . 1995;39:1191–1193.
Barbesier M, Boval C, Desfeux J, et al. Acute fatal coronary artery dissection following exercise-related blunt chest trauma. J Forensic Sci . 2015;60:233–235.
Dobiáš M, Hejna P, Mawiri AA. Coronary artery dissection: a fatal complication following blunt chest trauma. Forensic Sci Med Pathol . 2013;9:454–457.
Chen X, Zhang J, Deng Z, et al. A case of isolated ventricular septal rupture caused by blunt chest trauma. Rom J Leg Med . 2015;23:243–246.
Ordóñez NG. D2-40 and podoplanin are highly specific and sensitive immunohistochemical markers of epithelioid malignant mesothelioma. Hum Pathol . 2005;36:372–380.
Azzawi M, Hasleton PS, Kan SW, et al. Distribution of myocardial macrophages in the normal human heart. J Anat . 1997;191:417–423.
Azzawi M, Kan SW, Hillier V, et al. The distribution of cardiac macrophages in myocardial ischaemia and cardiomyopathy. Histopathology . 2005;46:314–319.
Abrunzo TJ. Commotio cordis. The single, most common cause of traumatic death in youth baseball. Am J Dis Child . 1991;145:1279–1282.