Key result
Computed tomography is the modality of choice for stable patients with pericardial trauma, accurately diagnosing pathologies such as pericardial fluid collections, focal defects, and pneumopericardium.
Multimodality imaging, particularly FAST and CT, is essential for the accurate diagnosis and triage of patients with traumatic pericardial injuries.
Supports CT preference in stable pericardial trauma; leaves open prospective validation against multimodality strategies.
BACKGROUND: Thoracic injuries are the third most common injuries in trauma patients with cardiac injuries amongst the most lethal. Imaging is essential in diagnosis and triage of patients with pericardial injuries, and this review aims to highlight the spectrum of imaging findings of pericardial trauma. Focussed assessment with sonography for trauma (FAST) is the preferred initial examination, being rapid and accurate. Sensitivity of FAST for pericardial fluid detection is high with reported sensitivities of 97-100%. Plain chest radiography has low sensitivity for pericardial injuries but is useful in the evaluation of associated injuries. Computed tomography (CT) is the modality of choice for stable patients and can accurately diagnose traumatic pathology of the pericardium being especially useful in identification of cardiac herniation. The spectrum of CT findings includes pericardial fluid collections, focal pericardial defects and pneumopericardium. METHODS: A selection of cases of pericardial trauma encountered at a level one trauma centre is presented. Operative findings were correlated with the FAST scan, plain radiography and computed tomography imaging. CONCLUSION: The imaging findings of pericardial trauma with various imaging modalities (ultrasound, plain radiography and computed tomography) are presented in order to aid interpretation during the acute trauma setting.
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Adams et al. (2012) conducted a review in Traumatic pericardial injuries. Imaging modalities (FAST, CXR, CT) was evaluated. Computed tomography is the modality of choice for stable patients with pericardial trauma, accurately diagnosing pathologies such as pericardial fluid collections, focal defects, and pneumopericardium.
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