Successful diagnosis of pericardial rupture caused by blunt chest trauma using contrast ultrasonography

A 65-year-old male developed acute myocardial infarction due to coronary artery dissectionand tricuspid valveinjury after bluntchest trauma. Acute myocardial infarction was treated by coronary artery intervention; however, refractory heart failure with pleural effusion remained. The first transthoracic echocardiography (TTE) on admission failed to clearly visualize the tricuspid valveand right ventricle due to poor image quality. A follow-up TTE with contrast ultrasonography revealed pericardial rupture in addition to tricuspid regurgitation. Ruptures of the tricuspid papillary muscleand pericardiumwere confirmed during surgery and were repaired successfully. Bluntchest trauma results in various cardiac injuries including cardiac rupture, intramural hematoma, valvular injury, coronary artery injury, and electrical disturbances, leading to critical conditions and high mortality. Of such blunt trauma-induced injuries, coronary artery dissection, tricuspid valveinjury, and pericardial rupture caused by bluntchest trauma are rare, and simultaneous occurrence of the three types of injuries that were successfully repaired has not been reported. In addition, this case indicates the utility of contrast ultrasonography for diagnosis of pericardial rupture caused by bluntchest trauma.