Trauma Case Rep. 2025 Nov 16;60:101279. doi: 10.1016/j.tcr.2025.101279. eCollection 2025 Dec.

BACKGROUND: Blunt cardiac chamber ruptures are rare and often fatal. These injuries are typically associated with overt chest trauma, making their diagnosis difficult when external signs are absent.

CASE PRESENTATION: We report the case of a 17-year-old male who sustained a right atrial appendage rupture with pericardial tamponade after a high-speed auto-versus-pedestrian collision. There was no evidence of chest injury, including rib fractures, upon presentation. The initial assessment revealed hemodynamic instability and a positive Focused Assessment with Sonography for Trauma (FAST) exam in the right upper quadrant, with equivocal pericardial space findings, prompting emergent exploratory laparotomy and pericardial window. Upon decompression of a significant pericardial effusion, cardiothoracic surgery identified and repaired a 2 cm defect of the right atrial appendage via emergent median sternotomy. The patient recovered well following surgical intervention and was discharged home on hospital day 12.

CONCLUSION: This case highlights the diagnostic challenge of blunt cardiac injury in the absence of apparent external chest trauma. It emphasizes the importance of maintaining a high index of suspicion for occult cardiac injury in patients with unexplained hypotension following high-energy mechanisms, even when chest imaging and exam findings are discordant. Early surgical intervention remains critical for survival in these rare but potentially survivable injuries.

PubMed:41333991 | PMC:PMC12666793 | DOI:10.1016/j.tcr.2025.101279