Stab wounds to the heart can present without clinical evidence of injury. Echocardiography has been advocated as an alternative to subxyphoid exploration in these cases. We present a case in which two serial echocardiography exams missed a diagnosis. Electrocardiographic changes and elevation of serial troponin I levels suggested the diagnosis, which was confirmed by thoracoscopy. Repair was facilitated by use of adenosine cardiac standstill.
TyburskiJ.G., AstraL., WilsonR.F., DenteC., SteffesC.Factors affecting prognosis with penetrating wounds of the heart.J Trauma2000; 48(4): 587–90; discussion 590–1.
5.
HarrisD.G., JansonJ.T., Van WykJ., PretoriusJ., RossouwG.J.Delayed pericardial effusion following stab wounds to the chest.Eur J Cardiothorac Surg2003; 23(4): 473–6.
6.
Mayor-DaviesJ.A., D'EgidioA., ScheinM.‘Missed stabbed hearts'—pitfalls in the diagnosis of penetrating cardiac injuries. Report of 4 cases.S Afr J Surg1992; 30(1): 18–9.
7.
NagyK.K., LohmannC., KimD.O., BarrettJ.Role of echocardiography in the diagnosis of occult penetrating cardiac injury.J Trauma1995; 38(6): 859–62.
8.
MeyerD.M., JessenM.E., GrayburnP.A.Use of echocardiography to detect occult cardiac injury after penetrating thoracic trauma: a prospective study.J Trauma1995: 39(5): 902–7; discussion 907–9.
Karmy-JonesR., VallieresE., KralovichK., GasparriM., SorensenV.J., HorstH.M.A comparison of rigid -v- video thoracoscopy in the management of chest trauma.Injury1998; 29(9): 655–9.
11.
LimR., GillI.S., TemesR.T., SmithC.E.The use of adenosine for repair of penetrating cardiac injuries: a novel method.Ann Thorac Surg2001: 71(5): 1714–5.
12.
Karmy-JonesR., YenT., CornejoC.Pericarditis after trauma resulting in delayed cardiac tamponade.Ann Thorac Surg2002; 74(1): 239–41.
13.
McCabeJ.C., EbertP.A., EngleM.A.Zabriskie JB. Circulating heart-reactive antibodies in the postpericardiotomy syndrome.J Surg Res1973; 14(2): 158–64.
14.
EhrenhaftJ.Taft R. Hemopericardium and constrictive pericarditis.J Thorac Surg1952; 24: 355–68.
15.
SalimA., VelmahosG.C., JindalA., ChanL., VassiliuP., BelzbergH.Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings.J Trauma2001; 50(2): 237–43.
