CTICasesBlunt Cardiac Injury with Myocardial Shear Strain
Imaging findings
Initial chest CT in a pediatric trauma patient reveals dependent airspace consolidation in the lower lobes consistent with pulmonary contusion and edema, without displaced sternal or rib fractures. Due to severely elevated troponin levels, a follow-up cardiac MRI was performed three days later. Late gadolinium enhancement (LGE) imaging demonstrates a patchy, non-ischemic, subepicardial and mid-myocardial pattern of enhancement involving the lateral wall of the left ventricle and the apex, with subtle edema on T2-weighted stir sequences.
Key takeaways
Blunt cardiac trauma can cause myocardial injury that characteristically involves the lateral wall of the left ventricle. This contra-coup pattern of injury is hypothesized to result from shear strain forces on the lateral wall during sudden anterior-posterior compression of the ventricle against the spine. Cardiac MRI with late gadolinium enhancement is highly sensitive for characterizing the extent and pattern of blunt myocardial injury and differentiating it from acute myocarditis.
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