Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 7-8, Pages: 440-442
https://doi.org/10.2298/SARH1608440N
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Subendocardial hemorrhages in a case of extrapercardial cardiac tamponade: A possible mechanism of appearance
Nikolić Slobodan (School of Medicine, Institute of Forensic Medicine, Belgrade)
Živković Vladimir (School of Medicine, Institute of Forensic Medicine, Belgrade)
Introduction. Subendocardial hemorrhages are grossly visible bleedings in the
inner surface of the left ventricle, the interventricular septum, and the
opposing papillary muscles and adjacent columnae carneae of the free wall of
the ventricle. These are commonly seen in sudden profound hypotension either
from severe blood loss from “shock” in the widest sense and, even more often,
in combination with brain injuries. Case Outline. We present a case of a
38-year-old man, injured as a car driver in a frontal collision, who died c.
45 minutes after the accident. The autopsy revealed severe chest trauma,
including multiple right-sided direct rib fractures with the torn parietal
pleura and right-sided pneumothorax, several right lung ruptures, and a
rupture of one of the lobar bronchi with pneumomediastinum, and prominent
subcutaneous emphysema of the trunk, shoulders, neck and face. The patchy
subendocardial hemorrhage of the left ventricle was observed. The cause of
death is attributed to severe blunt force chest trauma. Conclusion. We
postulate pneumomediastinum leading to extrapericardial tamponade as the
underlying mechanism of this subendocardial hemorrhage.
Keywords: forensic pathology, subendocardial hemorrhage, extrapericardial cardiac tamponade, pneumomediastinum, subcutaneous emphysema, lung injury
Projekat
Ministarstva nauke Republike Srbije, br. 45005