Myocardial contusion
Diagnosis almost certain
Updates to Case Attributes
Title
was changed:
Myocardial Contusioncontusion
Presentation
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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 heart problemscardiac 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 notexperience arrhytmiasarrhythmias, dispnoeadyspnoea, 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.
Body
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A strong impact to the front of the chest oftentimes results in myocardial contusion.
FracturedA 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.
-<p>A strong impact to the front of the chest oftentimes results in myocardial contusion.</p><p>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>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.</p>- +<p>A strong impact to the front of the chest oftentimes results in <a title="myocardial contusion" 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>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.</p>
References changed:
- Huguet M, Tobon-Gomez C, Bijnens BH, Frangi AF, Petit M. Cardiac injuries in blunt chest trauma. J Cardiovasc Magn Reson. 2009; 11: 35.
- Dellegrottaglie S, Pedrotti P, Pedretti S, Mauri F, Roghi A. Persistent myocardial damage late after cardiac contusion: depiction by cardiac magnetic resonance. J Cardiovasc Med. 2008; 11: 1177–1179.
- Vago H, Toth A, Apor A, Maurovich-Horvat P, Toth M, Merkely B. Cardiac Contusion in a Professional Soccer Player. Circulation. 2010; 121: 2456-2461.
Updates to Quizquestion Attributes
Question
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Which of the following diagnosis is the most probable one and why: myocarditis, myocardial contusion or myocardial infarction. ?
Updates to Study Attributes
Images Changes:
Image MRI (T2) ( update )
Description
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Myocardial oedema was still present 2.5 months after the injury. This is quite a long period for oedema to still be seen. Oedema is usually resolved much quicker with myocarditis or Tako-Tsubo myocardiopathyTakotsubo cardiomyopathy. Such a long period of resolution is sometimes seen with cases of myocardial infarction. And as we can see, myocardial contusion as well (it is still unclear whether injury to the myocard comes from direct conquasation / contusion of the tissue or indirectly from injury to the arteries or combination of both).
Image MRI (IRGRE) ( update )
Description
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PSIR sequence with nulled myocardium. Positive late enhancement in AHA 8 segment, indicatingfibrosis.
Image MRI (IRGRE) ( update )
Description
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Oblique late phase (~10 mins): PSIR sequence with nulled myocardium. Transmural late enhancement could indicate myocardial infarction, but the patch of LE is relatively small and does not correspond to coronary vascular territories. It could correspond to obstruction of a small septal LAD 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.