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Sacré-Cœur: a torn sac
  1. Catalin-Iulian Efrimescu,
  2. Andrew Westbrook
  1. Department of Anesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Dublin, Republic of Ireland
  1. Correspondence to Dr Catalin-Iulian Efrimescu, Department of Anesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Unit 224, No 3 Lombard Street East, Dublin 2, Republic of Ireland; catalin_efrimescu{at}yahoo.com

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Clinical introduction

A 39-year-old cyclist is brought to the emergency department after being hit by a car and thrown 7 m in the air.

On examination he was confused, agitated (Glasgow Coma Score 14/15) and presented with tachypnoea (RR 50), hypoxia (SpO2 75% on 15 L/min oxygen), tachycardia (heart rate 145) and hypotension (86/49 mm Hg). A focused assessment with sonography in trauma scan identified free fluid in Morrison's pouch. His chest X-ray is presented in figure 1.

Figure 1

Chest X-ray after bilateral chest drain insertion.

Question

What cardiovascular complication is more likely to be the consequence of the diagnosis established on the X-ray?

  1. Aortic dissection

  2. Cardiac herniation

  3. Myocardial rupture

  4. Ventricular aneurysm …

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