Extrapericardial tamponade following blunt chest trauma treated with subxiphoid uniportal video-assisted thoracoscopic surgery: a case report

TL;DR

A rare case of chest trauma leading to life-threatening compression was successfully treated with a minimally invasive surgical technique.

Contribution

This case report demonstrates the novel use of subxiphoid uniportal video-assisted thoracoscopic surgery in trauma for extrapericardial tamponade.

Findings

SUVATS successfully evacuated a mediastinal hematoma causing extrapericardial tamponade.

The minimally invasive approach allowed for sternal fixation and reduced postoperative complications.

SUVATS may serve as a less invasive alternative to traditional sternotomy in selected trauma cases.

Abstract

Anterior mediastinal hematomas following blunt chest trauma are usually not life threatening. However, in rare cases, they can cause extrapericardial tamponade, requiring urgent surgical intervention. Despite its increasing adoption in elective thoracic procedures, the use of subxiphoid uniportal video-assisted thoracoscopic surgery (SUVATS) in trauma remains scarcely reported. This case highlights a rare instance of extrapericardial tamponade caused by an anterior mediastinal hematoma, successfully managed using SUVATS in a trauma setting.

We report the case of a 65-year-old man who had a 4-meter fall and sustained a retrosternal hematoma and sternal fracture, as confirmed on chest computed tomography without evidence of intracardiac or major vascular injuries. Following initial hemodynamic stability, evolving hemodynamic compromise led to transthoracic echocardiography, which demonstrated right ventricular compression consistent with extrapericardial tamponade, necessitating surgical evacuation. SUVATS was performed for hematoma evacuation and hemostasis. During subsequent sternal fixation via a separate limited midline incision, thoracoscopic visualization enabled assessment of the posterior sternal surface. The patient was extubated on the day of surgery and was discharged without complications.

This case demonstrates the extended utility of SUVATS beyond hematoma evacuation, including its adjunctive role in sternal fixation. This minimally invasive approach provided excellent mediastinal exposure, reduced postoperative pain, and minimized respiratory complications. SUVATS may be a feasible option in selected trauma cases, including those with tamponade physiology. In trauma patients without major vascular injury, it may offer a less invasive yet effective alternative to median sternotomy, potentially improving early recovery and outcomes.

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