Penetrating cardiac injury with no initial radiological findings and negative E-FAST: The critical role of clinical judgment

Fig. 1. Chest X-ray showing left pleural effusion. Basal opacification of the left hemithorax with obliteration of the costophrenic angle is observed, suggestive of fluid accumulation in the pleural space.

Fig. 2. A. Intraoperative view during exploratory thoracotomy. The surgical field shows direct exposure of the heart with active bleeding from a penetrating cardiac injury, requiring immediate surgical control. B. Clots identified in the pericardial window. Intraoperative view showing clotted blood within the pericardial cavity following pericardial window opening, consistent with haemopericardium. C. Intraoperative control of the cardiac injury. The image shows surgical control of the cardiac lesion following pericardial opening and clot evacuation during exploratory thoracotomy.

Fig. 3. A. Chest X-ray demonstrating left pleural effusion. Chest radiograph showing opacification of the left hemithorax with blunting of the left costophrenic angle, consistent with pleural fluid accumulation after surgery. B. Follow-up chest X-ray demonstrating resolution of the left pleural effusion. The radiograph shows restoration of the left costophrenic angle and re-expansion of the lung following treatment.