Myocardial contusion

Case contributed by Gregor Savli , 13 Sep 2015
Diagnosis almost certain
Changed by Joachim Feger, 22 Aug 2020

Updates to Case Attributes

Body was changed:

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.

Myocardial oedema was still present 2.5 months after the injury, which is quite a long period and usually resolves much faster. Such a long period of resolution is sometimes seen with cases of myocardial infarction as well as from myocardial contusion. 

Transmural late gadolinium enhancement indicates myocardial scar tissue and could indicate myocardial infarction, but it is relatively small and does not correspond to coronary vascular territories. It could correspond to obstruction of a small septal branch, though. Once again - it is still unclear, whether myocardial changes after contusion come from direct injury, indirect injury (ischemia) due to damage to the local vessels or both. 

The sternal fracture at the level of the myocardial late gadolinium enhancement is quite a typical finding myocardial contusion.

  • -<p>A strong impact to the front of the chest oftentimes results in <a href="/articles/myocardial-contusion">myocardial contusion</a>.</p><p>A fractured sternum indicates high kinetic energy at the impact and elevated troponin levels and chest pain after such an injury confirm myocardial contusion.</p><p><a href="/articles/myocardial-oedema">Myocardial oedema</a> was still present 2.5 months after the injury, which is quite a long period and usually resolves much faster. Such a long period of resolution is sometimes seen with cases of myocardial infarction as well as from myocardial contusion. </p><p>Transmural <a title="Late gadolinium enhancement" href="/articles/late-gadolinium-enhancement-2">late gadolinium enhancement</a> indicates <a title="Myocardial scar tissue" href="/articles/myocardial-scar-tissue">myocardial scar tissue</a> and could indicate myocardial infarction, but it is relatively small and does not correspond to coronary vascular territories. It could correspond to obstruction of a small septal branch, though. Once again - it is still unclear, whether myocardial changes after contusion come from direct injury, indirect injury (ischemia) due to damage to the local vessels or both. </p><p>The sternal fracture at the level of the myocardial late quite a typical finding <a title="Myocardial contusion" href="/articles/blunt-cardiac-injury">myocardial contusion</a>.</p><p> </p>
  • +<p>A strong impact to the front of the chest oftentimes results in <a href="/articles/myocardial-contusion">myocardial contusion</a>.</p><p>A fractured sternum indicates high kinetic energy at the impact and elevated troponin levels and chest pain after such an injury confirm myocardial contusion.</p><p><a href="/articles/myocardial-oedema">Myocardial oedema</a> was still present 2.5 months after the injury, which is quite a long period and usually resolves much faster. Such a long period of resolution is sometimes seen with cases of myocardial infarction as well as from myocardial contusion. </p><p>Transmural <a href="/articles/late-gadolinium-enhancement-2">late gadolinium enhancement</a> indicates <a href="/articles/myocardial-scar-tissue">myocardial scar tissue</a> and could indicate myocardial infarction, but it is relatively small and does not correspond to coronary vascular territories. It could correspond to obstruction of a small septal branch, though. Once again - it is still unclear, whether myocardial changes after contusion come from direct injury, indirect injury (ischemia) due to damage to the local vessels or both. </p><p>The sternal fracture at the level of the myocardial <a title="Late gadolinium enhancement" href="/articles/late-gadolinium-enhancement-2">late gadolinium enhancement</a> is quite a typical finding <a href="/articles/blunt-cardiac-injury">myocardial contusion</a>.</p><p> </p>

Updates to Study Attributes

Images Changes:

Image MRI (cine GRE) ( update )

Description was removed:
Same as before. Local hypokinesia and myocardial early enhancement.

Image MRI (IRGRE) ( update )

Specifics changed from late phase (~10 mins) to IRGRE.

Image MRI (IRGRE) ( update )

Specifics changed from LGE to IRGRE.

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