J.Jpn. Surg. Soc.. 84(11): 1138-1148, 1983

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Original article

CLINICAL AND PATHOPHYSIOLOGICAL STUDY OF MYOCARDIAL CONTUSION

Myocardial contusion was observed in 25 patients (7.5%) out of 333 blunt chest trauma victims. As the cause of injury, 19 patients (76%) were due to traffic accident and 12 out of 19 patients had steering wheel injuries. There were a total of 72 associated thoracic injuries, and this means 2.9 injuries for each patients. As ECG abnormalities, sinus tachycardia on admission and ST, T change in time course were mostly found in this series. Chest X-ray findings revealed the maximum value (55.2±1.3%) of CTR (cardio-thoracic ratio) on the 2nd～4th hospital days, followed the decreasing tendency. CPK-MB showed its peak on the 1st～3rd hospital days, and was nearly normalized on the 5th hospital day. There were 10 expired cases, and the mortality was 40%. Cardiac death due to cardiac tamponade or cardiogenic shock was observed in 4 cases. Ventricular function study showed 2 right ventricular dysfunction, 1 left ventricular dysfunction, and 4 biventricular dysfunction, and showed extremely poor prognosis in the biventricular dysfunction group. The cases of myocardial contusion were classified into the following 3 types by the clinical findings.
TypeI : ECG abnormality type 13 cases
Type II : Cardiac tamponade type 7 cases
Type III : Cardiogenic shock type 6 cases
I conclude that measuring the ventricular function is useful for the evaluation of the severity and prognosis of myocardial contusion if the blunt chest trauma victim is in shock state.

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