Papillary muscle rupture of the mitral valve following blunt thoracic trauma.

Blunt cardiac injury is caused by large deceleration forces seen in motor vehicle accidents and can range from non-life-threatening arrhythmias to potentially fatal cardiac conditions such as valve disruption. A 28-year-old man presented following a motor vehicle accident involving direct blunt-force chest trauma. He developed papillary muscle rupture resulting in mitral valve dysfunction. Diagnosis was delayed due to concomitant chest pathology. Diagnosis of cardiac valvular injuries may be difficult due to concomitant injuries in a trauma patient. Though rare, papillary muscle rupture should be included in the differential diagnosis following blunt thoracic trauma, particularly involving persistent hypoxemia.

A Rare Case of Urinothorax as a Result of Penetrating Trauma.

Urinothorax, defined as urine within the pleural space, is an uncommon finding in published trauma literature. To date, there are less than ten recorded cases of non-iatrogenic trauma-induced urinothorax, most resulting from blunt traumatic injuries from motor vehicle collisions. Given the rarity of the condition, the diagnosis is often missed or delayed. Once the diagnosis is suspected, the most reliable finding is a pleural fluid to serum creatinine ratio of >1. A confirmed diagnosis of urinothorax then requires drainage of pleural fluid and management of distal ureteral obstruction. Unfortunately, the added complexity of the poly-trauma patient obscures this difficult diagnosis often leading to a delay in treatment and prolonged hospital stay. No current published literature exists on penetrating trauma as a cause of urinothorax. Here, we describe a unique case of urinothorax in a 32-year-old male as a result of penetrating trauma.

Cardiac tamponade secondary to iatrogenic needle decompression in blunt force trauma.

The proper treatment for tension pneumothorax is rapid needle decompression. This procedure is frequently performed in the field for trauma patients who have clinical symptoms of pneumothorax. The procedure itself has a high rate of failure due to improper placement, operator inexperience, or chest wall thickness. A 22-year-old unrestrained driver in a high-speed motor vehicle collision was found unconscious and subsequently had needle decompression for decreased breath sounds in the field. The patient was initially stable upon arrival but progressed to cardiac arrest. She had a thoracotomy in the emergency department that showed cardiac tamponade followed by return of spontaneous circulation. On formal thoracotomy, it was discovered that the patient had an iatrogenic cardiac injury from the angiocatheter placed during needle decompression. Needle decompression is a lifesaving procedure, but it is associated with high failure rates and possibility for iatrogenic injury.

A Rare Case of Fat Embolism Syndrome Masquerading as COVID-19 Pneumonia.

In the wake of the novel coronavirus disease 2019 (COVID-19) pandemic and its associated mortality and virulence, a high clinical suspicion must be maintained for all patients presenting with respiratory failure. However, there are well-known disease processes that may have a similar presentation. We present a case of a 25-year-old male who suffered a right tibia fracture after a motor vehicle collision. He had acute hypoxic respiratory failure within 24 hours of admission, requiring mechanical ventilation. His condition significantly improved with airway pressure release mode of ventilation and proning. Although his chest CT demonstrated characteristic findings of COVID-19, he subsequently tested negative. The differential included aspiration pneumonia and fat embolism syndrome from the lower extremity fracture. Fat embolism syndrome can very closely mimic COVID-19. The rapid onset and improvement of symptoms coupled with serial negative COVID-19 testing may aid in the diagnosis.

Idiopathic Aortitis With Retroperitoneal Fibrosis Course and Its Treatment.

Aortitis is an inflammatory phenomenon involving one or more layers of the aorta and can have infectious or noninfectious etiologies. Complications of aortitis include aneurysm, dissection, and rupture, which can lead to ischemic organs and ultimately death. Noninfectious aortitis is often secondary to trauma or results from a systemic inflammatory process. It is further categorized based on clinical characteristics, laboratory findings, and imaging. There are some cases in which the etiology cannot be determined and is, therefore, idiopathic in nature. We present a case of a 67-year-old male who presented with malaise, abdominal pain, anorexia, and significant weight loss for several months. Imaging revealed retroperitoneal fibrosis and aortitis. After an extensive workup, we diagnosed idiopathic aortitis and treated the patient with high-dose corticosteroids that led to symptom improvement.

A systematic review and meta-analysis of impact of baseline thrombocytopenia on cardiovascular outcomes and mortality in patients undergoing percutaneous coronary intervention.

BACKGROUND: Thrombocytopenia (TP) is associated with higher incidence of bleeding in the setting of percutaneous coronary intervention (PCI) leading to increased morbidity and mortality. Herein, we report a meta-analysis evaluating the effects of baseline thrombocytopenia (bTP) on cardiovascular outcomes in patients undergoing PCI. METHODS: Literature search was performed using PubMed, Embase, Cochrane library and clinicaltrials.gov from inception till October 2019. Patients were divided into two groups: Patients with (a) no Thrombocytopenia (nTP) (b) bTP before PCI. Primary endpoints were in-hospital, and all-cause mortality rates at the longest follow-up. The main summary estimate was random effects risk ratio (RR) with 95% confidence intervals (CIs). RESULTS: A total of 6,51,543 patients from 10 retrospective studies were included. There was increased in-hospital all-cause mortality (RR 2.58 [1.7-3.8], p < .001) and bleeding (RR 2.37 [1.41-3.98], p < .005), in the bTP group compared to the nTP group. There was no difference for in-hopsital major adverse cardiovascular outcomes (MACE) (RR 1.38 [0.94-2.0], p < .10), post-PCI MI (RR 1.17 [0.9-1.5], p = .19) and TVR (RR 1.65 [0.8-3.6], p = .21), respectively. Outcomes at longest follow-up showed increased incidence of all-cause mortality (RR 1.86 [1.2-2.9], p < .006) and bleeding (RR 1.72 [1.1-2.9], p = .04) in bTP group, while there was no significant difference for post-PCI MI (RR 1.07 [0.91-1.3], p = .42), MACE (RR 1.86 [0.69-1.8], p = .68) and TVR (RR 1.1 [0.9-1.2], p = .93) between both groups. CONCLUSIONS: bTP in patients undergoing PCI is associated with increased mortality and predicts risk of bleeding.