Traumatic pericardial rupture with skeletonized phrenic nerve

Traumatic pericardial rupture is a rare presentation. Pericardial rupture itself is asymptomatic unless complicated by either hemorrhage or herniation of the heart through the defect. Following diagnosis surgical repair of the pericardium is indicated because cardiac herniation may result in vascular collapse and sudden death. Here we present a case of traumatic, non-herniated pericardial rupture with complete skeletonization of the phrenic nerve. An 18-year-old healthy male suffered multi-trauma after falling 50 feet onto concrete. The patient could not be stabilized despite exploratory laparotomy with splenectomy, IR embolization and packing for a liver laceration. Right posterolateral thoracotomy revealed a ruptured pericardium with a completely skeletonized phrenic nerve. The pericardium was repaired with a Goretex(R) patch. A high level of suspicion for pericardial rupture is necessary in all patients with high-velocity thoracic injuries.