Letter to the Editor
Myocardial Contusion and Pericardial Effusion After Blunt Chest Trauma
Contusión miocárdica y derrame pericárdico tras traumatismo esternal cerrado asintomático
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Plano paraesternal corto: derrame pericárdico posterior (flecha). B) TAC torácica: se evidencia fractura esternal, así como derrame pericárdico leve (flecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Patricia Fariña Ruiz, Elisabeth Medina Darias, Carlos Enrique García Franco, Marcos Rodríguez Esteban" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana Patricia" "apellidos" => "Fariña Ruiz" ] 1 => array:2 [ "nombre" => "Elisabeth" "apellidos" => "Medina Darias" ] 2 => array:2 [ "nombre" => "Carlos Enrique" "apellidos" => "García Franco" ] 3 => array:2 [ "nombre" => "Marcos" "apellidos" => "Rodríguez Esteban" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173507713000896" "doi" => "10.1016/j.cireng.2013.07.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => 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Biliopancreatic Bypass Without Gastrectomy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "204" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Bypass</span> biliopancreático laparoscópico sin gastrectomía por puerto único" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 640 "Ancho" => 900 "Tamanyo" => 82057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Exterior photo of the single port.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joaquín Resa 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array:3 [ "nombre" => "Elisabeth" "apellidos" => "Medina Darias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "Carlos Enrique" "apellidos" => "García Franco" "email" => array:1 [ 0 => "c.garciafranco@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "Marcos" "apellidos" => "Rodríguez Esteban" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponing author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Contusión miocárdica y derrame pericárdico tras traumatismo esternal cerrado asintomático" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 543 "Ancho" => 1301 "Tamanyo" => 98978 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Echocardiogram 2D; parasternal short-axis plane: posterior pericardial effusion (arrow). (B) Thoracic CT: evidence of sternal fracture, as well as mild pericardial effusion (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with great interest the recent and interesting contribution by Dr. Francia et al. about a case of late cardiac tamponade due to myocardial contusion.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We would like to make certain observations regarding a similar case that we have recently treated.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 70-year-old woman came to our emergency department after having undergone the Heimlich maneuver because of choking. Upon admittance, the patient was conscious, oriented, with stable respiratory function and hemodynamics. She only presented mild pain on palpation in the lower sternal region, with no associated signs or symptoms. Three hours after hospitalization, ECG and myocardial enzymes presented no alterations (troponin I: 0.20<span class="elsevierStyleHsp" style=""></span>ng/ml). Chest X-ray showed a simple sternal fracture in the distal third of the sternum. The patient remained under observation, and after 8<span class="elsevierStyleHsp" style=""></span>h her enzymes began to rise progressively (troponin I: 0.62), although the ECG was normal. After 24<span class="elsevierStyleHsp" style=""></span>h, high enzyme levels peaked (troponin I: 0.92) and there was evidence of inverted T-waves in leads V1–V3 on the ECG. Echocardiogram showed mild pericardial effusion and hypokinesis of the medial and apical anteroseptal segments with maintained EF (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Chest CT demonstrated the sternal fracture and the aforementioned pericardial effusion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), with no other findings. With the diagnosis of myocardial contusion, the patient was admitted to the cardiology ward for 12 days. She evolved favorably, with no progression of the pericardial effusion, although electrocardiographically she presented more T-wave inversion in the anterior wall and minimal elevation of ST in I and aVL. Coronary catheterization showed normal coronary branches.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">As for the initial description of the case by Dr. Francia, we would like to point out that any sternal trauma of less than 24<span class="elsevierStyleHsp" style=""></span>h, even though apparently trivial, can entail serious complications. Thus, in cases of recent sternal trauma, it is advisable to maintain the patient under observation for at least 24<span class="elsevierStyleHsp" style=""></span>h in order to rule out any possible myocardial contusion and resulting complications.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This measure would be recommendable even in asymptomatic patients because, as it has been demonstrated both in the case described by the authors as well as in ours, the initial absence of noticeable symptoms and signs does not rule out the possibility that serious complications may present. During the observation period, we would emphasize the need for electrocardiography and myocardial enzyme monitoring<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in order to quickly detect possible myocardial injuries. Lastly, we should underline the association between myocardial contusion and pericardial effusion, as seen in both cases described. We coincide with the authors in considering that echocardiogram is fundamental when there is a suspicion of these entities.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fariña Ruiz AP,et al. Contusión miocárdica y derrame pericárdico tras traumatismo esternal cerrado asintomático. Cir Esp. 2013;91:205-6.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 543 "Ancho" => 1301 "Tamanyo" => 98978 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Echocardiogram 2D; parasternal short-axis plane: posterior pericardial effusion (arrow). (B) Thoracic CT: evidence of sternal fracture, as well as mild pericardial effusion (arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Taponamiento cardiaco tardío por contusión miocárdica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Francia Ramos" 1 => "O.N. Mederos Curbelo" 2 => "R. del Campo Abad" 3 => "J.C. García Sierra" 4 => "O. Villafranca Hernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2010.06.020" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2012" "volumen" => "90" "paginaInicial" => "468" "paginaFinal" => "469" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21514579" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosing cardiac contusion: old wisdom and new insights" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.C. Sybrandy" 1 => "M.J.M. Cramer" 2 => "C. Burgersdijk" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2003" "volumen" => "89" "paginaInicial" => "485" "paginaFinal" => "489" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12695446" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myocardial contusion injury: redefining the diagnostic algorithm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.K. Bansal" 1 => "D. Chewaproug" 2 => "A. Amanullah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/emj.2004.015339" "Revista" => array:6 [ "tituloSerie" => "Emerg Med J" "fecha" => "2005" "volumen" => "22" "paginaInicial" => "465" "paginaFinal" => "469" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15983078" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009100000003/v1_201309090012/S2173507713000896/v1_201309090012/en/main.assets" "Apartado" => array:4 [ "identificador" => "19061" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009100000003/v1_201309090012/S2173507713000896/v1_201309090012/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713000896?idApp=UINPBA00004N" ]
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