Myocardial contusion

Case contributed by Dr Gregor Savli

Presentation

Man was hit by a large rock while driving a car. Rock flew through the windshield and hit him to the front of his chest, fracturing the sternum. Troponin T was elevated at 22 on the first day. He was previously healthy, without any cardiac history, so the coronarography was not performed, only heart ultrasound, where no abnormalities were noticed. Troponin levels were diminishing afterwards, reaching Troponin I value of 0.184 on the 11th day. The patient did not experience arrhythmias, dyspnoea, fatigue or any other possible heart related problems in the course of these days. For reasons not quite clear (maybe to be absolutely sure about the diagnosis), cardiac MRI was requested 2.5 months after the injury.

Patient Data

Age: 51
Gender: Male
Modality: MRI

Myocardial oedema, late enhancement, early enhancement and hypokinesia in AHA segment 8 (anteroseptal).

Case Discussion

A strong impact to the front of the chest oftentimes results in myocardial contusion.

A fractured sternum indicates high kinetic energy at the impact and elevated Troponin levels and chest pain after such an injury confirm myocardial contusion.

When cardiac MRI is performed, we look for all the typical changes, that occur with the myocardial infarction, myocarditis or other cardiac pathology. We can see myocardial oedema and early enhancement, which can persist for some months and we usually see area of myocardial late enhancement, that can be transmural, but does not correspond to the vascular territories.

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Case Information

rID: 39640
Case created: 13th Sep 2015
Last edited: 15th Sep 2015
System: Cardiac
Inclusion in quiz mode: Included

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