Commotio cordis without arrhythmic event and resuscitation: ECG, echocardiographic, angiographic and cardiovascular resonance imaging study.

We describe a case of commotio cordis in which the patient had an extensive cardiac evaluation, including ECGs, a coronary angiogram, a left ventriculogram, repeated echocardiography and cardiovascular MRI (CMRI). A healthy 17-year-old boy sustained an open-handed blow to the anterior part of the chest from a friend with whom he was playing. On admission ECG was performed that showed ST-T alterations and a TNI increase, with echocardiographic evidence of a localised pericardial effusion associated with a persistent myocardial blush at selective angiography. In addition, CMRI confirmed a local delayed enhancement in the same zone. An echocardiogram examination performed 30 days after discharge showed a complete disappearance of pericardial effusion and an improvement on ECG alterations. This is the first case report of a patient with commotio cordis, who did not show any arrhythmias and did not receive any resuscitation procedure, and was extensively studied by imaging methods.

[Sudden death caused by a less lethal weapon chest-wall injury (Commotio cordis)]. / Commotio cordis après impact précordial de Flashball.

Less lethal weapons, like Flashball, are more and more used since 1995 in law enforcement, even by the local police to neutralize combative individuals and to disperse riot crowds. This gun fires large rubber bullets and has been incriminated many times in cases of face injuries with functional consequences. In this case report, we mention a case of sudden death from cardiac arrest due to low energy chest wall impact of a rubber bullet shot with the Flashball. Commotio cordis is potentialized by a lethal set of three including, a certain impact velocity, an exact location of the hit over the cardiac silhouette, and a precise timing 15 m/s prior to the peak of the T-wave. This case report highlights the fact that such impacts can cause significant injury to internal organs, in particular circonstances, implying the necessity of a raising awareness of the medical staff, in ordre to not underestimate the severity of such injuries.