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Blunt Traumatic Cardiac Rupture Presenting as Massive Haemothorax

Cardiac rupture following blunt thoracic trauma in motor vehicle crash generally causes death at scene, and is rarely diagnosed preoperatively. However, early emergency thoracotomy in the emergency department (ED) or operating room might reduce the mortality but the benefit is still controversial. A haemodynamically unstable 28-year-old woman following motor vehicle crash was detected to have right haemothorax on chest X-ray. Thoracic computed tomography (CT) revealed additional lung contusions and multiple bone fractures. She developed cardiac arrest during open thoracotomy and had restored spontaneous circulation after open-chest cardiopulmonary resuscitation (CPR). This report highlights that CT scan in haemodynamically unstable patients could delay surgical control of the injury. Open-chest CPR can be life-saving for blunt chest injury developing cardiac arrest. (Hong Kong j.emerg.med. 2015;22:320-323)