(1552) Acute Pericarditis After Penetrating Thoracic Trauma: Case Series at a Level One Trauma Center

Introduction: Posttraumatic pericarditis is a distinct entity from other causes of pericarditis, with tamponade occurring rarely. These syndromes manifest with fever and pleuritic chest pain and may stem from an inflammatory or autoimmune pericardial reaction to trauma, pericardial, or pleural incisions; however, no large contemporary series exist describing their occurrence.

Description: Three patients who developed pericarditis after penetrating trauma were admitted to an urban level 1 trauma center from November 2020 to January 2023.

All patients were male and healthy prior to injury; two adult patients and one adolescent patient who experienced at least one gunshot wound to the chest were included. Each patient developed significant hemodynamic instability related to initial or subsequent cardiac injury; two patients experienced cardiac arrest with subsequent resuscitation. Patient 1 had left ventricular (LV) and bilateral lung injuries and underwent clamshell thoracotomy and LV repair. Acute pericarditis was diagnosed on hospital day (HD) 7 and treated with indomethacin. Patients 2 and 3 had thoracoabdominal injuries without cardiac injury; both underwent damage control laparotomies including splenectomy and diaphragm repair on index operation. Pericarditis was diagnosed on HD 12 and 14, respectively, and both required a pericardial window. Intraoperatively, these patients were found to have constrictive pericarditis with inflammatory rind and epicardial fibrinous deposits. All patients survived to discharge.

Discussion: Our series demonstrates that acute pericarditis, effusive or constrictive, can occur in the first weeks following penetrating thoracic trauma, even without direct cardiac injury.