Isolated Pericardial Rupture is a Rare Occurrence Associated with Blunt Thoracic Trauma—Incidentally Discovered during Videothoracoscopy: A Case Report

Aim and background: Isolated pericardial rupture from blunt thoracic trauma is rare and often underdiagnosed due to its nonspecific presentation and high prehospital mortality.Unlike pericardial injuries involving cardiac or great vessel trauma, isolated rupture without herniation or tamponade poses a diagnostic and therapeutic challenge.The paucity of reported cases in the literature limits the development of standardized management guidelines, making clinical decision-making highly dependent on individual case characteristics and physician experience.Although surgical intervention is often warranted to prevent life-threatening complications, recent reports suggest that conservative management may be a viable option in hemodynamically stable patients without evidence of cardiac displacement.Here, we present a case of an isolated pericardial rupture in a patient with blunt thoracic trauma, emphasizing the diagnostic approach, therapeutic considerations, and the role of nonoperative management in selected cases.Case description: We report a 22-year-old Hispanic male involved in a high-energy motorcycle crash.Initially stabilized at a rural hospital, he was transferred to a trauma center with severe neurological compromise and suspected thoracic trauma.On admission, he had a Glasgow Coma Scale score of 4/15, hemodynamic instability, and signs of flail chest and hemopneumothorax.Imaging confirmed right-sided hemopneumothorax, multiple rib fractures, lung lacerations, and an incidentally diagnosed pericardial rupture without cardiac herniation during video-assisted thoracoscopic surgery (VATS).Management included chest tube thoracostomy, VATS-guided lung decortication, rib stabilization, and bronchopleural fistula closure.The pericardial rupture was managed conservatively.The patient developed ventilator-associated pneumonia (VAP), which was successfully treated, and was discharged without complications.Conclusion: This rare finding highlights the importance of recognizing isolated pericardial rupture in blunt trauma.Conservative management may be an option in stable cases, emphasizing the need for individualized treatment and multidisciplinary care.This case contributes to the limited literature on blunt isolated pericardial rupture and emphasizes the potential role of conservative management in selected patients.Clinical significance: This report highlights a rare case of isolated pericardial rupture managed conservatively, adding valuable insights to the literature.