FAST imaging of extrapericardial cardiac tamponade caused by mediastinal hematoma: A case report of blunt chest trauma

Most sternal fractures can be conservatively treated. Herein, we report a rare case of extrapericardial cardiac tamponade due to mediastinal hematoma secondary to sternal fracture and internal thoracic artery injury. A 54-year-old man was hospitalized for blunt chest trauma after an accident. He was in shock on arrival, and initial echocardiography revealed extrapericardial cardiac tamponade caused by an epicardial hematoma. Contrast-enhanced computed tomography showed extravasation from the sternal fracture and cardiac compression due to mediastinal hematoma. Emergency surgery was performed for hematoma removal, the internal thoracic artery on the sternal fracture surface was identified as the bleeding source, and hemostasis was performed. The postoperative course was good. Extrapericardial cardiac tamponade due to mediastinal hematoma secondary to sternal fracture and internal thoracic artery injury due to blunt chest trauma is a rare presentation requiring extreme caution. Surgical intervention should be considered despite the lack of treatment consensus.