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← Section VI · Miscellaneous Topics (Role of Echo)
VI.F

Trauma

5 cards

Notes

Blunt cardiac injury

  • Deceleration or direct blow (motor vehicle crash, fall).
  • Spectrum: cardiac contusion → chamber rupture.
  • Screen with ECG + troponin.
  • Echo indicated for: hemodynamic instability, arrhythmia, abnormal cardiac silhouette on CXR, mediastinal widening.

Findings

  • Cardiac contusion - regional WMA, most commonly in RV (anterior).
  • Traumatic AR - leaflet avulsion, chordal rupture, papillary muscle rupture.
  • VSD - usually apical, from septal shearing.
  • Free-wall rupture - rapidly fatal.
  • Pericardial effusion → tamponade.
  • Aortic transection - most commonly at the aortic isthmus (just distal to the left SCA); TEE 95 % sensitive.
  • Commotio cordis - SCD from blunt precordial impact during ventricular vulnerable period.

Penetrating trauma

  • Stab or gunshot wound.
  • Any wound in "cardiac box" (bordered by mid-clavicular lines, sternal notch, xiphoid) → screen with echo.
  • Findings: pericardial effusion (tamponade), foreign body, chamber injury.
  • Urgent operative exploration when tamponade or unstable.

Iatrogenic trauma

  • Catheter perforation (RV, RA).
  • Guidewire injury.
  • TEE-related esophageal injury (< 2 % complications; mortality < 0.02 %).
  • Pacemaker/ICD lead perforation.

Cards

  • basicVI.F-001
    After blunt chest trauma, which chamber is most commonly affected by contusion, and why?
    → The right ventricle — it lies closest to the sternum. Regional wall motion abnormalities in the anterior RV free wall are typical of blunt cardiac contusion.
  • basicVI.F-002
    Where does traumatic aortic transection most commonly occur, and what imaging modality is highly sensitive?
    → At the aortic isthmus (just distal to the left subclavian artery — the ligamentum arteriosum tethering point). TEE has ~95% sensitivity; CT angiography is now the standard first study.
  • basicVI.F-003
    What is commotio cordis?
    → Sudden cardiac death from a blunt precordial impact during the ventricular vulnerable period (upslope of the T wave). Common in young athletes struck by a baseball or similar projectile.
  • basicVI.F-004
    Following blunt chest trauma with hypotension, what echo finding requires immediate action?
    → Pericardial effusion with tamponade physiology — RV diastolic collapse, RA inversion, IVC plethora — or evidence of free-wall or chamber rupture. Requires urgent surgical exploration or pericardiocentesis.
  • basicVI.F-005
    What is the 'cardiac box' in penetrating trauma?
    → Anatomical region on the anterior chest bounded by the sternal notch (superior), xiphoid process (inferior), and midclavicular lines (lateral). Any penetrating wound within this box requires echo screening for cardiac injury.