Initial Imaging Evaluation of a Patient with Penetrating Cardiac Injury

Penetrating cardiac injury is frequently lethal. Reported mortality rates vary from 3% to 84% depending on whether “prehospital” mortality is included . In patients who reach the hospital, a lower survival rate for those with
firearm injuries (33%) than for those with stab wounds (65%) has been described . In one recent large study, improvement in the survival
rate was noted for both patient populations, possibly due to improved prehospital care .
Anterior cardiac chambers are more commonlyinjured than posterior chambers, and ventricles are more commonly injured than atria. Injuries involve (in decreasing order of frequency) the right ventricle, left ventricle, right atrium, and left atrium .
The initial imaging of affected patients usually includes a portable supine chest radiograph . This imaging may reveal an abnormal mediastinal contour from mediastinal hematoma or enlargement of the cardiac silhouette from hemopericardium and, in gunshot injuries, bullet fragments and/or the bullet trajectory .

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