Polytrauma: Cardiac Compartment Syndrome Caused by an Unstable, Bleeding Thoracic Vertebral Body Fracture

A man in his 60s in hemodynamic shock was transported by emergency medical services to a level-1 trauma center after an e-bike accident and prehospital cardiopulmonary resuscitation (CPR).

As part of emergency room management, a whole-body CT was conducted (Figures a and b). Imaging revealed life-threatening injuries including a massively bleeding distraction fracture of the T10 vertebral body. Subsequently, a large compressive para-aortic hematoma (“cardiac compartment syndrome”) developed as an ultra-rare entity, resulting in hemodynamically relevant compression of the right atrium. Additional injuries included, among others, an unstable injury to the upper cervical spine (C2) with spinal cord injury (ISS 75).

Figure

Polytrauma, whole-body computed tomography (a: sagittal reconstruction, b: axial reconstruction; Siemens Somatom X.ceed spectral CT): A bleeding and unstable distraction fracture of the T10 vertebral body (black asterisk) with an intraspinal hematoma extending from T6 to T10 (a and b, black arrows). In the posterior mediastinum (red asterisk a; b: aorta), a massive, ultra-rare compressive para-aortic hematoma (“cardiac compartment syndrome”) extending from T6 to T12 (a and b, red arrows) and resulting in significant hemodynamic compression of the right atrium (b, white arrows) was detected.

Emergency room management according to the ATLS® protocol (ABCDE approach) revealed severe C (circulation) and D (disability) problems. An emergency thoracotomy was then performed to decompress the hematoma, resulting in immediate cardiopulmonary stabilization. Furthermore, the spinal injuries were treated using navigation-guided and robot-assisted techniques.

During the course of further intensive care, a devastating hypoxic brain injury was observed on CT, MRI, and EEG. The patient subsequently died following limitation of treatment in accordance with his advance healthcare directive.

Dominik M. Haida, Prof. Dr. med. Stefan Huber-Wagner, Klinik und Poliklinik für Unfallchirurgie, TUM Klinikum, Rechts der Isar,
School of Medicine and Health, Technische Universität München und Klinik für Unfallchirurgie, Wirbelsäulenchirurgie und Alterstraumatologie,
DIAK Klinikum Landkreis Schwäbisch Hall, [e-mail]

Dr. med. Thorsten Möhlig, Klinik für Unfallchirurgie, Wirbelsäulenchirurgie und Alterstraumatologie, DIAK Klinikum Landkreis Schwäbisch Hall

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

Cite this as: Haida DM, Möhlig T, Huber-Wagner S: Polytrauma: cardiac compartment syndrome caused by an unstable, bleeding thoracic vertebral body fracture.
Dtsch Arztebl Int 2026; 123: 422. DOI: 10.3238/arztebl.m2026.0097

Photos: Institute for Diagnostic and Interventional Radiology DIAK Klinikum Landkreis Schwäbisch Hall, Germany, Head of Department: Prof. Dr. M. Libicher