# An unexpected finding of cardiac injury penetrating the diaphragm in a suspected abdominal trauma case

## TL;DR

An elderly man with an abdominal stab wound had a rare cardiac injury through the diaphragm, requiring urgent surgery for recovery.

## Contribution

This case highlights the diagnostic complexity of 'junctional zone' trauma involving both cardiac and abdominal structures.

## Key findings

- Penetrating abdominal trauma can cause cardiac injury through the diaphragm.
- Emergency thoracotomy and sternotomy were critical for diagnosing and treating right ventricular injury.
- Successful resuscitation was achieved despite advanced age and initial misdiagnosis.

## Abstract

We report a rare case of penetrating abdominal trauma involving right ventricular injury. An 81-year-old man presented with a stab wound in the upper abdomen and hemodynamic instability. Hemorrhagic shock was initially suspected to be due to intra-abdominal organ damage. Emergency laparotomy revealed no evidence of intra-abdominal organ injury; however, subsequent thoracotomy and sternotomy identified cardiac tamponade from right ventricular injury caused by a penetrating object that traversed the diaphragm. Prompt surgical intervention enabled successful resuscitation. This case highlights the diagnostic challenge of “junctional zone” trauma, where both thoracic and abdominal organs may be involved. Despite advanced age, the patient was discharged in good condition.