From blunt chest trauma to broken heart: imaging features of a neglected diagnosis
Authors: Galzerano D , Al Admawi M , Alshahid M , Al Amri M , Kholaif N , Aljheish S , Alzaher S , Bhutta M , Khaliel F , Pergola V , Di Salvo G , Alamro B 
Published: January 2025

Abstract

Background/Introduction
Blunt chest trauma is a leading cause of mortality, with a significant portion of deaths attributed to cardiac injuries. These cardiac injuries can range from mild contusions to life-threatening ruptures. Imaging plays a crucial role in evaluating suspected cardiac injury after chest trauma. This study highlights the importance of a comprehensive imaging approach in this critical setting.

Purpose
This study aims to investigate the presentations and diagnostic challenges of a wide range of cardiac injuries following blunt chest trauma, emphasizing the crucial role of cardiac imaging in identifying these injuries.

Methods
This study retrospectively investigates patients' presentations, diagnostic challenges, and imaging finding in diagnosing cardiac injuries following blunt chest trauma. We reviewed medical records of thirteen patients diagnosed with these injuries over a twelve-year period.

Results
Our study investigated cardiac injuries following blunt chest trauma. We analyzed thirteen patients' cases (Figure 1). Tricuspid valve regurgitation was the most frequent diagnosis, affecting seven patients. The potential for delayed presentation makes diagnosing these cases challenging, as patients with this injury may remain asymptomatic for many years following the trauma. One patient had a left main artery dissection (Figure 2 panel D cardiac 3D computed tomography; red arrow pointing to dissection within the distal left main coronary artery at the site of atheroma, with a small vascular outpouching, representing a false lumen) and another patient had severe mitral regurgitation due to partial rupture of the anterior papillary muscle post chest trauma. Additionally, two patients had ventricular septal defects (Figure 2 Panel C cardiac MRI; red arrow pointing to large muscular ventricular septal defect at the mid - apical segment with left to right shunt; LV: left ventricular, RV: right ventricular, LA: left atrium, RA:Right atrium, AA:ascending aorta).
We observed another very rare complication post chest trauma an aortic valve aneurysm causing severe aortic regurgitation. Additionally, another patient with a bicuspid aortic valve developed post chest trauma flail and tear of the aortic valve cusp (Figure 2 Panel A, 2D transthoracic echocardiography, parasternal long axis views red arrow pointing to flail and tear of aortic valve cusp, panel B; 2D transthoracic echocardiography with color, parasternal long axis views red arrow pointing to severe aortic regurgitation jet directed towards the anterior mitral leaflet).

Conclusion(s)
This study highlights the challenges of diagnosing cardiac injuries after chest trauma. It emphasizes the importance of maintaining a high index of suspicion for these injuries in patients with blunt chest trauma. A focused examination and utilization of imaging can improve diagnostic accuracy, guide optimal patient management, and ultimately prevent complications and improve outcomes.
Figure 1
Figure 2