Cardiac Tamponade from Displaced Rib Fracture and Intercostal Artery injury Via Pleural-Pericardial communication without Heart Chamber or Great Vessel Involvement

Cardiac tamponade occurs when a pericardial effusion leads to shock physiology. The fluid in the pericardium can be exudative, transudative, or sanguineous arising from multiple different etiologies. Furthermore, the faster the effusion develops, the less volume needed for the development of tamponade physiology. This makes prompt diagnosis and treatment of paramount importance, especially in trauma settings where multiple injuries need to be triaged appropriately. This patient was a 91-year-old female who underwent a motor vehicle collision versus tree as a restrained driver. She was stable on arrival but quickly decompensated in the emergency department requiring placement of a chest tube and infusion of blood products. Patient was taken to the operating room for pericardial window after a CT scan identified a moderate sized pericardial effusion. Intraoperatively, large volume bloody pericardial effusion was encountered requiring median sternotomy to control bleeding. The source of the bleed was an intercostal artery bleeding into the Left pleural space that was communicating with the pericardium via a disrupted parietal pericardium violated by a displaced rib fracture.