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A 79-year-old man had an out-of-hospital acute ST-segment-elevation myocardial infarction with cardiac arrest. Cardiopulmonary resuscitation performed by a bystander resulted in traumatic hemopericardium. We discuss the patient's case, highlight the challenges of managing simultaneously life-threatening thrombosis and hemorrhage, and present our conclusions regarding the patient's eventual death.

To our knowledge, only 15 cases of delayed traumatic hemopericardium resulting from non-penetrating chest trauma have been reported. We present the case of a 63-year-old man with delayed hemopericardium, 2 months after striking the anterior chest on a mailbox when he fell down three steps during a postal delivery. Our case and review of the previously reported cases suggest that some cases might show quite slow progression of blood accumulation. Therefore, careful observation of patients who have experienced blunt trauma of the anterior chest is necessary.

Diagnosis of ST-segment elevated myocardial infarction (STEMI) can be challenging when alternative causes of ST-segment elevation coexist. Patients with hemopericardium with acute pericarditis frequently exhibit ST-segment elevations on electrocardiogram (ECG). However, recognition of coronary

Background High-energy blunt chest injury will bring out severe cardiac and pulmonary injuries. It may cause cardiac contusion, rupture, cardiac valve dysfunction, and aortic laceration [1]. As traumatic hemopericardium occurs, ultrasound is a convenient and reliable tool for diagnosis. We presented a 55-year-old male victim of blunt chest trauma complicated with hemopericardium, cardiac tamponade, cardiac contusion and epicardial hematoma.

Ten patients with pericardial fluid who also had striking band-like intrapericardial echoes by two-dimensional ultrasonic sector scanning are reported. Four patients had prior mediastinal radiation and four patients had severe renal disease. One patient had purulent pericarditis and one patient had traumatic hemopericardium. The two-dimensional images permitted recognition of loculation of fluid and led to the suspicion of thickened pericardial membranes. Three postradiation patients had both tamponade and constriction; tamponade alone was present in four additional patients. These data are preliminary but suggest that such findings by two-dimensional echocardiography should alert us to consider an effusive-constrictive form of pericardial disease.

Chronic constrictive pericarditis following traumatic hemopericardium has been reported in recent years, but it has not been reproduced experimentally in dogs. The present study attempted to produce posttraumatic constrictive pericarditis in 34 experimental animals. Hemopericardium by means of trauma to the epicardium or pericardium was produced by a sharp instrument or by the injection of autologous blood inside the pericardial sac. All animals were killed at intervals between 3 and 31 months. The animals in which hemopericardium was induced by injecting blood into the pericardial cavity showed no changes. The hemopericardium was completely resolved without noticeable residual trace. Animals having hemopericardium as a result of trauma evidenced a well-developed constrictive pericarditis that was documented clinically, hemodynamically, and histologically. These experimental findings indicate that chronic constrictive pericarditis may well be due to traumatic hemopericardium rather than to specific infection.

MOST physicians believe that death ensues rapidly after penetrating wounds of the heart. In a Philadelphia police station a prisoner was recently found dead in a cell with 3 other men. The medical examiner noted at autopsy that the man had been stabbed with an ice pick, and was quoted as saying that the stabbing could not have occurred more than an hour before death and that the victim probably died within twenty minutes.1 The other 3 men were suspected of the killing until it was discovered that the victim had been stabbed three days before death. He had walked . . .

A four and a half year old girl with delayed appearance of traumatic hemopericardium, detected radiologically despite misleading clinical manifestations, is presented. The presence of cardiomegaly and a needle in the right upper mediastinum on the chest roentgenogram and its partial motion together with diminished cardiac pulsations at fluoroscoopy led to angiocardiography. The radiological demonstration of hemopericardium due to the needle penetrating the aortic root, enabled successful surgical intervention.