Cardiac herniation into pleural space and subcutaneous emphysema

Cardiac herniation into left pleural space and huge subcutaneous emphysema

Bruno José da Costa Medeiros
Surgery Institute of Amazonas' State, Manaus, Amazonas, Brazil  

A patient male, 45 years of age was brought to our trauma hospital after fall from a light pole (7 m of high), presenting shortness of breath and a huge subcutaneous emphysema. After the first assessment (oxygen supply and analgesia), the patient got better. He was transferred to imaging department; a computed tomography scan was performed. A huge subcutaneous emphysema surrounding the entire chest [Figure 1], a cardiac herniation into left pleural space [Figure 2] and a bilateral pneumothorax and right hemothorax were observed. The patient underwent bilateral blunt chest tube thoracostomy after that was transferred to cardiothoracic unit. He recovered well from the thoracotomy executed by cardiothoracic team.

Figure 1: Huge subcutaneous emphysema surrounding the entire chest, small right hemothorax Click here to view

Figure 2: Cardiac herniation into left pleural space, red arrow shows the right circumference of pericardial sac, blue arrow shows the heart herniated into pleural space Click here to view

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