Traumatic rupture of interventricular septum proved by cardiac catheterization.

RUPTURE of the interventricular septum due to trauma is a rare phenomenon, according to Pollock, Markelz and Shuey,1 who reviewed all the reported cases up to 1952 and found a total of 12 proven traumatic interventricular defects. This report concerns a patient who developed an interventricular septal defect following severe trauma to the chest that was proven by cardiac catheterization. CASE REPORT A 38-year-old white man was admitted to the University Hospitals of Cleveland after the milk delivery truck that he was driving was struck by another ear. The patient had been crushed against the chest-high center platform of his truck by cases of milk falling from a shelf behind him. The blow was sudden and compressed the left chest anteroposteriorly. On his admission, the pulse was 104, the respirations were 24 and the blood pressure was 104/68; he was in obvious respiratory distress from multiple rib fractures of the left chest. The right chest was clear to percussion and auscultation, and the left chest revealed hyperresonance to percussion, decreased breath sounds and tactile fremitus. Subcutaneous emphysema was present in the left axilla and neck. Except for multiple lacerations and abrasions of the face and extremities, no other serious injuries were noted. The patient's early hospital course was marked by chest pain, dyspnea and cyanosis, but by the fifth day in the hospital there was marked improvement and on the eighteenth day the patient was discharged. Adequate auscultation of the left chest anteriorly was not possible, because of pain and a traumatic pneumothorax, until the patient