Cardiac tamponade due to a displaced rib fracture: a case report

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Suspected blunt cardiac injury (myocardial contusion) following blunt chest trauma (n=5359). Intervention: Diagnostic testing (ECG, CPK-MB, TTE, TEE, cTnI, cTnT) vs. Reference standard for blunt cardiac injury (autopsy, imaging, or clinical complications). Primary outcome: Diagnostic accuracy (sensitivity, specificity, and diagnostic odds ratio) for detecting blunt cardiac injury.

Q: What does this research mean for the field?

Displaced rib fractures resulting from blunt trauma can lead to cardiac tamponade in initially hemodynamically stable patients, highlighting the utility of serial eFAST examinations. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Alwin Puthiyakunnel Saji; André Dubois; George Bailey; Andres Diaz; Archna Ashok Tolani; Antanas Mačys; Maryam Alfa‐Wali

doi:10.20408/jti.2025.0243

October 29, 2026Journal of Trauma and InjuryOpen Access

Cardiac tamponade due to a displaced rib fracture: a case report

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Why the study?

Pericardial effusion causing cardiac tamponade is uncommon following blunt traumatic injury.

What is the diagnostic accuracy of ECG, CPK-MB, TEE, TTE, cTnT, and cTnI for detecting blunt cardiac injury and its complications in patients with blunt chest trauma?

Key Points

To describe a case of cardiac tamponade secondary to a displaced rib fracture after blunt trauma and highlight the importance of repeated bedside ultrasonography.
Case report detailing the presentation, clinical evaluation, and clinical course of a 78-year-old woman involved in a road traffic collision.
Serial diagnostic evaluations conducted using repeated extended focused assessment with sonography in trauma (eFAST) alongside hemodynamic monitoring.
The patient was initially hemodynamically stable following the road traffic collision but subsequently developed pericardial effusion causing cardiac tamponade secondary to a displaced rib fracture.
Repeated eFAST examinations identified the delayed pericardial effusion, underscoring the necessity of close monitoring in blunt trauma to enable prompt management and reduce morbidity and mortality.

Study Design

Type

Meta-Analysis (n=5,359)

Multicenter

Yes

Structured PICO

What is the diagnostic accuracy of ECG, CPK-MB, TEE, TTE, cTnT, and cTnI for detecting blunt cardiac injury and its complications in patients with blunt chest trauma?

P

Population

5,359 patients across 51 studies with blunt chest trauma evaluated for suspected blunt cardiac injury (weighted mean age 38.7 years; 73.3% male among those with cardiac injury).

E

Exposure

Diagnostic tests for blunt cardiac injury: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), transoesophageal echocardiography (TEE), transthoracic echocardiography (TTE), cardiac troponin T (cTnT), and cardiac troponin I (cTnI).

C

Comparator

Reference standards for cardiac injury (autopsy-proven contusion/laceration, Echo/CT/MRI/radionuclide scan-proven injury, free wall rupture, coronary artery thrombosis, congestive heart failure, or serious arrhythmias/conduction blocks).

O

Outcome

Diagnostic accuracy (sensitivity, specificity, positive likelihood ratio [PLR], negative likelihood ratio [NLR], diagnostic odds ratio [DOR]) in the diagnosis of blunt cardiac injury and its complications.

Limitations

Included non-randomized studies (case series, case-control, and cohort studies) primarily of Level IV evidence
Significant heterogeneity across studies in laboratory reference thresholds, reagent calibrations, and timing of blood sampling
Publication bias was not assessed
Small number of studies evaluating TEE prevented ROC curve calculation
Excluded patients who died on the scene prior to hospital evaluation and did not evaluate serial biomarker or repeated ECG measurements
Patients with cardiac injuries that result in immediate death on site are generally not included in studies
16 out of 51 studies exhibited an unclear risk in patient selection applicability, and 7 exhibited an unclear risk in flow and timing bias
49 of the 51 included articles were level IV evidence (42 case series, 7 case-control) and 26 were retrospective
TTE cannot be used in patients with severe chest wall injuries due to pain, while TEE requires advanced skills, sedation, and is contraindicated in oesophageal injury

Implication

In patients with blunt chest trauma, combining a normal ECG with a normal troponin I is an effective and pragmatic strategy to rule out blunt cardiac injury, while transoesophageal echocardiography offers high diagnostic accuracy for confirming suspected cases.

Abstract

Pericardial effusion causing cardiac tamponade is uncommon following blunt traumatic injury. We report the case of a 78-year-old woman who, following a road traffic collision, developed cardiac tamponade secondary to a displaced rib fracture. This case also demonstrates the value of repeated extended focused assessment with sonography in trauma (eFAST). Close monitoring of patients who are initially hemodynamically stable, in the context of their mechanism of injury, is essential in trauma care to reduce the morbidity and mortality that can occur without prompt management.

Discussion

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Cite This Study

Saji et al. (2026) conducted a meta-analysis in Suspected blunt cardiac injury (myocardial contusion) following blunt chest trauma (n=5,359). Diagnostic testing (ECG, CPK-MB, TTE, TEE, cTnI, cTnT) vs. Reference standard for blunt cardiac injury (autopsy, imaging, or clinical complications) was evaluated on Diagnostic accuracy (sensitivity, specificity, and diagnostic odds ratio) for detecting blunt cardiac injury.

synapsesocial.com/papers/6ae585c34c46c197bbab4fd3 https://doi.org/10.20408/jti.2025.0243

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Cardiac tamponade due to a displaced rib fracture: a case report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiac tamponade due to a displaced rib fracture: a case report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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