Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot Injury

Abstract

Introduction: Gunshot injuries to the thoracic cavity are relatively common and considered high risk for cardiac involvement. However, current literature shows that the incidence of cardiac damage does not differ significantly when comparing various aetiologies of penetrating chest injuries [1].

The most common predictive factors for cardiac injury include clinical manifestations, missile trajectory or anatomical wound location, and the number of chest wounds [2]. However, injuries to the heart and mediastinal vessels are often fatal and are therefore considered leading causes of death following trauma [3].

Most patients suffering from an acute traumatic cardiac injury present with hemodynamic instability and cardiac tamponade, which can subsequently lead to high mortality rates [4, 5]. Therefore, a patient with a gunshot thoracic injury, especially transmediastinal, who is hemodynamically stable and shows no clinical signs or symptoms of cardiac injury, may have underlying injuries.

We present a rare case of a stable gunshot trans -mediastinal wound patient, with initial retained haemothorax after thoracentesis, and finally diagnosed with partial heart herniation.

Conclusions: Partial heart herniation following a transmediastinal gunshot wound is a rare and potentially life-threatening condition that may present without classic signs of cardiac injury. This case emphasizes the importance of maintaining a high index of suspicion for occult cardiac trauma in hemodynamically stable patients with thoracic gunshot injuries. Timely imaging, thorough evaluation, and minimally invasive surgical exploration, such as VATS, can play a critical role in diagnosing and managing such atypical presentations, ultimately improving outcomes.