Trauma of the Pericardial Sac and Heart: An Autopsy Series

Abstract

From 145 consecutive autopsies on traffic fatalities and leaps from heights performed by one author were found 38 cases with laceration of the heart, laceration of the pericardial sac, or contusion of the heart. Twenty-eight subjects had pericardial laceration: 13 of the left side singly, eight of the right side singly, one of the anterior wall singly, and six with multiple lacerations. Five of the 13 had herniation of the heart into a pleural cavity. Twenty-one of the 38 had laceration of the heart; 12 multiple and nine singly. The lacerations were equally distributed between atria and ventricles but almost all the atrial lacerations involved the right atrium. Thirteen of the 38 subjects had contusion of the heart in the absence of a cardiac laceration. Two of them also had a sprain injury of the intrapericardial portion of the inferior vena cava. The contusions were in epicardial fat depots in the atrioventricular sulci and along the acute and obtuse margins of the heart. None of the contusions was confined to the myocardium. Eleven of the 38 had a sternal fracture and 30 had rib fractures. Major craniocervical trauma and lacerations of the liver, spleen, aorta, and lung were common. Only six of 38 ever had a pulse after the crash or leap. The longest survival was 3.75 hours. Pericardial lacerations most commonly occurred in the unbuttressed parts of the pericardium, namely, the left and right pleuropericardia. Pericardial laceration is essentially a traumatic rupture caused when the heart is compressed between the sternum and vertebral column and the sac gives way.