Intraoperative transesophageal echocardiography in blunt thoracic trauma.

C ARDIAC INJURY commonly occurs in patients who sustain blunt thoracic trauma; the incidence in patients who survive transport to a hospital has been estimated at 10% to 20% depending on the diagnostic criteria used.‘-8 Most commonly, the injury is limited to myocardial contusion and the structural integrity of the heart remains intact.’ Although the signs and symptoms of significant cardiac structural damage are often obvious, as in cardiac tamponade due to chamber rupture, in other cases they may be subtle, being masked or mimicked by previous cardiac surgery or myocardial infarction. Cardiac murmurs caused by traumatic valvular or septal rupture may not be heard in a noisy emergency room. The hemodynamic consequences of structural cardiac damage may not be immediately apparent due to multiple injuries and severe hypovolemia. Frequently other significant intrathoracic injuries coexist with cardiac damage: which may require urgent operation, thereby postponing tests such as twodimensional (2D) surface echocardiography that would diagnose clinically undetected cardiac injury. A case of right atria1 and tricuspid valve rupture is presented that was not clinically apparent in a patient with a previous myocardial infarction and coronary artery surgery. The diagnosis was made using 2D transesophageal echocardiography (TEE) in the operating room during thoracotomy for a related noncardiac injury.