Obstructive shock from delayed blunt cardiac injury after chest trauma

Abstract

Blunt cardiac injury (BCI) is a rare but serious presentation in emergency departments (EDs) nationwide. These injuries arise in trauma and may be accompanied by confounding injuries that complicate the clinical picture. Timely recognition is crucial, as BCI may lead to complications such as pericarditis or life-threatening cardiac tamponade. Notably, there are no current guidelines on approaches in evaluating BCI. 1 We describe a patient who presents one week after a motor vehicle accident (MVA) with delayed BCI manifesting as pericarditis. After an extensive literature search, we found only one similar case—highlighting limitations in the current discussion. Importantly, our case is unique because the patient was initially unable to provide a medical history, and point of care ultrasound (POCUS) was pivotal in the initial evaluation. BCI remains challenging due to variable presentation and potential for delayed symptoms, as seen in this case. This case underscores the importance of maintaining a high index of suspicion for BCI, particularly in patients with chest trauma who delay seeking care or present with limited history. Further, early intervention is critical in preventing life-threatening sequelae. Utilizing a combination of physical examination, imaging, and laboratory findings can guide clinicians in accurate diagnosis of BCI. Our report contributes to a limited body of literature by documenting a delayed pericardial complication one week post-MVA, highlighting the need for broader awareness and more structured diagnostic pathways for BCI.