Computed Tomography Screens Stable Patients at Risk for Penetrating Cardiac Injury

Objective: To determine the accuracy of CT of the chest in diagnosing the presence of cardiac injury in stable pitients with penetrating chest injuries.
Methods: A retrospective chart review of a convenience sample of stable patients with penetrating thoracic wounds evaluated for hemopericardium using chest CT at an urban level I trauma center.
Results: 60 stable patients with penetrating wounds in proximity to the heart underwent CT. Three patients had radiographic evidence of pericardial fluid, and 1 had an equivocal study. These 4 patients underwent subxiphoid pericardial window exploration: 2 had only clear fluid present, the other 2 had hemopericardium. The latter patients had a total of 3 cardiac and 1 diaphragmatic injuries, which were repaired at subsequent sternotomy. None of the 56 patients who had negative CTs had further clinical evidence of cardiac injury. The sensitivity, specificity, and accuracy of CT in this setting for hemopericardium are 100% (95% CI 18–100%). 96.6% (95% CI 88–100%). and 96.7% (95% CI 89–100%), respectively.
Conclusion: Chest CT may be a useful test for diagnosing the presence of hemopericardium in the setting of penetrating thoracic injury. With the caveat that the patient must be removed from a closely monitored environment, the authors advocate the use of CT in stable patients with penetrating chest wounds whenever echocardiography is unavailable.