Even though a sternal fracture in the setting of trauma is considered a benign condition, myocardial contusion and myocardial concussion leading to malignant ventricular arrhythmias can be encountered with this finding only if there are ECG changes and cardiac troponin levels are rising. It is difficult to predict which patients with a sternal fracture will develop cardiac complications. In a cohort of 54 patients with a suspected sternal fracture by emergency physicians in a multicenter descriptive retrospective study, only 72% of the patients had ECG performed at baseline, 33% had follow-up ECG, and 30% had troponin I assessment; in this group, 6% of the patients were diagnosed with arrhythmias and myocardial contusion. The authors also showed that only 38 (70%) of the patients with suspected sternal fractures were confirmed by imaging [24]. This study shows the importance of diagnosing sternal fractures in conjunction with ECG monitoring and troponin assessment to evaluate cardiac Blunt Chest Trauma-Suspected Cardiac Injury injury in the setting of blunt trauma. However, it is noteworthy that echocardiography is not recommended in isolated sternal fractures in the presence of a normal ECG and cardiac troponins to evaluate for myocardial contusion [25]. The use of CT chest without IV contrast is of paramount importance in patients with prior chest surgery or retained metal fragments for accurate diagnosis of cardiac trauma and concomitant vascular injuries. CT Chest Without and With IV Contrast CT chest with and without IV contrast is the most effective routine imaging modality for detecting thoracic injuries caused by blunt trauma. It accurately detects hemorrhage within the chest followed by identification of concomitant cardiovascular injuries as a source of bleeding.
Blunt Chest Trauma Suspected Cardiac Injury. Even though a sternal fracture in the setting of trauma is considered a benign condition, myocardial contusion and myocardial concussion leading to malignant ventricular arrhythmias can be encountered with this finding only if there are ECG changes and cardiac troponin levels are rising. It is difficult to predict which patients with a sternal fracture will develop cardiac complications. In a cohort of 54 patients with a suspected sternal fracture by emergency physicians in a multicenter descriptive retrospective study, only 72% of the patients had ECG performed at baseline, 33% had follow-up ECG, and 30% had troponin I assessment; in this group, 6% of the patients were diagnosed with arrhythmias and myocardial contusion. The authors also showed that only 38 (70%) of the patients with suspected sternal fractures were confirmed by imaging [24]. This study shows the importance of diagnosing sternal fractures in conjunction with ECG monitoring and troponin assessment to evaluate cardiac Blunt Chest Trauma-Suspected Cardiac Injury injury in the setting of blunt trauma. However, it is noteworthy that echocardiography is not recommended in isolated sternal fractures in the presence of a normal ECG and cardiac troponins to evaluate for myocardial contusion [25]. The use of CT chest without IV contrast is of paramount importance in patients with prior chest surgery or retained metal fragments for accurate diagnosis of cardiac trauma and concomitant vascular injuries. CT Chest Without and With IV Contrast CT chest with and without IV contrast is the most effective routine imaging modality for detecting thoracic injuries caused by blunt trauma. It accurately detects hemorrhage within the chest followed by identification of concomitant cardiovascular injuries as a source of bleeding.