Pericardial Rupture Following Deceleration Trauma

Figure

Figure a: Unenhanced computed tomography of a polytrauma patient; the sagittal lung window is shown. Unstable serial rib fracture on the left (*), pneumothorax with soft tissue emphysema, posterior lung contusion, pneumopericardium due to pericardial rupture (arrow) with herniation of the left ventricle Figure b: Intraoperative view, left anterolateral thoracotomy; extensive pericardial rupture with exposed myocardium (*), the arrow markings indicate the edges of the ruptured pericardium (ventral, caudal and posterior)

Whole-body computed tomography scanning in a 71-year-old female patient following high-velocity deceleration trauma revealed the following chest findings in addition to various injuries (Figure a): unstable left hemithorax with fracture of the manubrium sterni, displaced fractures of the 1^st–8^th ribs, pneumopericardium and pneumothorax with soft tissue emphysema, as well as atelectasis of the lower lobe of the lung with mediastinal displacement. Emergency surgery confirmed long-segment rupture of the pericardium with subtotal cardiac luxation (blunt injury to the heart) (Figure b), which was repaired using a pericardial patch strategy. Postoperatively, the patient developed a persistently elevated diaphragm due to traumatic neurolysis of the phrenic nerve. Pericardial rupture following blunt trauma is a rare injury that primarily occurs as a result of deceleration. Due to the risk of cardiac luxation pericardial ruptures are life-threatening. The mortality rate is 30–64%. The morphological hallmark seen on computed tomography is pneumopericardium, which develops either due to alveolar rupture resulting from a sudden increase in intrathoracic pressure (Macklin effect) or through the direct entry of air in the case of a pleuropericardial injury. If a valve mechanism is present, there is a risk that pericardial tamponade may develop. Although this can cause air artifacts, echocardiography (eFAST) is mandatory for diagnosis. Thoracoscopy or thoracotomy should be performed as soon as possible to confirm the definitive diagnosis and initiate surgical treatment.

Philipp Jawny, Dr. S. Raab, Dr. S. Reindl, Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Jawny P, Raab S, Reindl S: Pericardial rupture following deceleration trauma. Dtsch Arztebl Int 2026; 123: 8a. DOI: 10.3238/arztebl.m2025.0101