Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot Injury
Introduction: Gunshot injuries to the thoracic cavity are relatively common and considered high risk for cardiac involvement. However, current literature shows that the incidence of cardiac damage does not differ significantly when comparing various aetiologies of penetrating chest injuries [1]....
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Albanian Society for Trauma and Emergency Surgery
2025-07-01
|
| Series: | Albanian Journal of Trauma and Emergency Surgery |
| Subjects: | |
| Online Access: | https://journal.astes.org.al/AJTES/index.php/AJTES/article/view/465 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849716157970382848 |
|---|---|
| author | Hagar Levy Shachar Ron Daskal Yury Peysakhovich Mansoor Khan Boris Kessel |
| author_facet | Hagar Levy Shachar Ron Daskal Yury Peysakhovich Mansoor Khan Boris Kessel |
| author_sort | Hagar Levy Shachar |
| collection | DOAJ |
| description |
Introduction: Gunshot injuries to the thoracic cavity are relatively common and considered high risk for cardiac involvement. However, current literature shows that the incidence of cardiac damage does not differ significantly when comparing various aetiologies of penetrating chest injuries [1].
The most common predictive factors for cardiac injury include clinical manifestations, missile trajectory or anatomical wound location, and the number of chest wounds [2]. However, injuries to the heart and mediastinal vessels are often fatal and are therefore considered leading causes of death following trauma [3].
Most patients suffering from an acute traumatic cardiac injury present with hemodynamic instability and cardiac tamponade, which can subsequently lead to high mortality rates [4, 5]. Therefore, a patient with a gunshot thoracic injury, especially transmediastinal, who is hemodynamically stable and shows no clinical signs or symptoms of cardiac injury, may have underlying injuries.
We present a rare case of a stable gunshot trans -mediastinal wound patient, with initial retained haemothorax after thoracentesis, and finally diagnosed with partial heart herniation.
Conclusions: Partial heart herniation following a transmediastinal gunshot wound is a rare and potentially life-threatening condition that may present without classic signs of cardiac injury. This case emphasizes the importance of maintaining a high index of suspicion for occult cardiac trauma in hemodynamically stable patients with thoracic gunshot injuries. Timely imaging, thorough evaluation, and minimally invasive surgical exploration, such as VATS, can play a critical role in diagnosing and managing such atypical presentations, ultimately improving outcomes.
|
| format | Article |
| id | doaj-art-9a1bfd29ed814c9f93dc6bfd9c2ba401 |
| institution | DOAJ |
| issn | 2521-8778 2616-4922 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Albanian Society for Trauma and Emergency Surgery |
| record_format | Article |
| series | Albanian Journal of Trauma and Emergency Surgery |
| spelling | doaj-art-9a1bfd29ed814c9f93dc6bfd9c2ba4012025-08-20T03:13:07ZengAlbanian Society for Trauma and Emergency SurgeryAlbanian Journal of Trauma and Emergency Surgery2521-87782616-49222025-07-019210.32391/ajtes.v9i2.465Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot InjuryHagar Levy Shachar0Ron Daskal1Yury Peysakhovich2Mansoor Khan3Boris Kessel4Division of General Surgery and Trauma, Hillel Yaffe Medical Center, affiliated with Rappaport Medical School, Technion, Haifa,Division of General Surgery and Trauma, Hillel Yaffe Medical Center, affiliated with Rappaport Medical School, Technion, Haifa,Cardio-thoracic Surgery Department, Rabin Medical Center, affiliated with Sackler University, Tel Aviv,Regional Medical Director Europe, Middle East, and South Asia, Iqarus Gulf FZ LLC, Dubai, UAE Department of Medical Education,Division of General Surgery and Trauma, Hillel Yaffe Medical Center, affiliated with Rappaport Medical School, Technion, Haifa, Introduction: Gunshot injuries to the thoracic cavity are relatively common and considered high risk for cardiac involvement. However, current literature shows that the incidence of cardiac damage does not differ significantly when comparing various aetiologies of penetrating chest injuries [1]. The most common predictive factors for cardiac injury include clinical manifestations, missile trajectory or anatomical wound location, and the number of chest wounds [2]. However, injuries to the heart and mediastinal vessels are often fatal and are therefore considered leading causes of death following trauma [3]. Most patients suffering from an acute traumatic cardiac injury present with hemodynamic instability and cardiac tamponade, which can subsequently lead to high mortality rates [4, 5]. Therefore, a patient with a gunshot thoracic injury, especially transmediastinal, who is hemodynamically stable and shows no clinical signs or symptoms of cardiac injury, may have underlying injuries. We present a rare case of a stable gunshot trans -mediastinal wound patient, with initial retained haemothorax after thoracentesis, and finally diagnosed with partial heart herniation. Conclusions: Partial heart herniation following a transmediastinal gunshot wound is a rare and potentially life-threatening condition that may present without classic signs of cardiac injury. This case emphasizes the importance of maintaining a high index of suspicion for occult cardiac trauma in hemodynamically stable patients with thoracic gunshot injuries. Timely imaging, thorough evaluation, and minimally invasive surgical exploration, such as VATS, can play a critical role in diagnosing and managing such atypical presentations, ultimately improving outcomes. https://journal.astes.org.al/AJTES/index.php/AJTES/article/view/465heart herniationpenetrating cardiac injurythermal pericardial injuryVATS |
| spellingShingle | Hagar Levy Shachar Ron Daskal Yury Peysakhovich Mansoor Khan Boris Kessel Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot Injury Albanian Journal of Trauma and Emergency Surgery heart herniation penetrating cardiac injury thermal pericardial injury VATS |
| title | Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot Injury |
| title_full | Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot Injury |
| title_fullStr | Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot Injury |
| title_full_unstemmed | Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot Injury |
| title_short | Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot Injury |
| title_sort | partial heart herniation an unusual manifestation of trans mediastinal gunshot injury |
| topic | heart herniation penetrating cardiac injury thermal pericardial injury VATS |
| url | https://journal.astes.org.al/AJTES/index.php/AJTES/article/view/465 |
| work_keys_str_mv | AT hagarlevyshachar partialheartherniationanunusualmanifestationoftransmediastinalgunshotinjury AT rondaskal partialheartherniationanunusualmanifestationoftransmediastinalgunshotinjury AT yurypeysakhovich partialheartherniationanunusualmanifestationoftransmediastinalgunshotinjury AT mansoorkhan partialheartherniationanunusualmanifestationoftransmediastinalgunshotinjury AT boriskessel partialheartherniationanunusualmanifestationoftransmediastinalgunshotinjury |