Traumatic laceration of the posterior left ventricle diagnosed by transesophageal echocardiography.

A 49-year-old man presented with a stab wound to the left chest. On physical examination, he had jugular venous distention and distant heart sounds; a trauma ultrasound showed a large pericardial effusion. Emergency thoracotomy revealed a large amount of blood and clot in the pericardial space and rapid hemorrhage from a laceration of the right ventricular free wall that was repaired with sutures. A transthoracic echocardiogram the next day revealed a large muscular ventricular septal defect. A follow-up transesophageal echocardiogram confirmed the presence of a muscular ventricular septal defect (Figure 1 and Movie I in the online-only Data Supplement), but it also surprisingly demonstrated a nearly full-thickness laceration of the posterior wall of the left ventricle (Figure 2 and Movie II in the online-only Data