Cardiac herniation is refers to herniation of heart outside its expected position. It can be intrathoracic or extrathoracic.
A cardiac herniation secondary to pericardial rupture is rare, but a highly lethal injury with most patients dying before arrival at a hospital.
Diagnosis in survivors is often delayed because initial chest radiography results are normal or show nonspecific abnormalities before cardiac herniation through the pericardial tear.
Pericardial tears range from short and insignificant to long tears that may lead to cardiac herniation. Tears 8-12 cm in length are associated with cardiac herniation, 90% of which occur along the left pleuropericardium.
A cardiac herniation can also occur following cardiac / thoracic surgery4 .
CT has shown pericardial tears before cardiac herniation and herniation itself.
Signs of a tear include focal pericardial discontinuity; pneumopericardium; and interposition of lung between the aorta and pulmonary artery, heart and diaphragm, or right atrium and right ventricular outflow tract; signs similar to congenital absence of the pericardium.
The primary sign of herniation is cardiac displacement when no large pleural effusion, atelectasis, or tension pneumothorax accounts for this displacement.
Pneumopericardium is non-specific, but a large volume of unilateral gas within the pericardium is more diagnostic of cardiac herniation, and has been termed the empty pericardial sac.
- ectopia cordis: congenital anomalous position of the heart outside the thorax
- 1. Wielenberg AJ, Demos TC, Luchette FA et-al. Cardiac herniation due to blunt trauma: early diagnosis facilitated by CT. AJR Am J Roentgenol. 2006;187 (2): W239-40. doi:10.2214/AJR.05.1785 - Pubmed citation
- 2. Holloway B, Mukadam M, Thompson R et-al. Cardiac herniation and lung torsion following heart and lung transplantation. Interact Cardiovasc Thorac Surg. 2010;10 (6): 1044-6. doi:10.1510/icvts.2009.227983 - Pubmed citation
- 3. Sherren PB, Galloway R, Healy M. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports. Scand J Trauma Resusc Emerg Med. 2009;17 (1): 64. doi:10.1186/1757-7241-17-64 - Free text at pubmed - Pubmed citation
- 4. Kawamukai K, Antonacci F, Di Saverio S et-al. Acute postoperative cardiac herniation. Interact Cardiovasc Thorac Surg. 2011;12 (1): 73-4. doi:10.1510/icvts.2010.245282 - Pubmed citation
- 5. Janson J, Harris D, Pretorius J et-al. The Annals of Thoracic Surgery. 2003;75 (2): . doi:10.1016/S0003-4975(02)04298-4
- 6. Wright M, Nelson C, Johnson A et-al. Thorax. 1970;25 (6): . doi:10.1136/thx.25.6.656
- 7. Adams A, Fotiadis N, Chin JY et-al. A pictorial review of traumatic pericardial injuries. Insights Imaging. 2012;3 (4): 307-11. doi:10.1007/s13244-012-0177-9 - Free text at pubmed - Pubmed citation