Survival after Right Ventricular Diverticulum Caused by Right Ventricular Rupture

Case Report and Brief Review of the Literature

Abstract

Ventricular diverticula can be divided into congenital and acquired ventricular diverticulum. Cardiac rupture is a rare occurrence of cardiac injury, but the mortality rate is very high. Some cardiac ruptures may form an acquired ventricular diverticulum. We report the case of a 57-year-old man who presented with a right ventricular diverticulum caused by traumatic ventricle rupture.

A 57-year-old man was admitted with chest pain and dyspnea after falling from a high place. His condition gradually stabilized after emergency surgery and rescue treatment. One week later, the patient suddenly presented with swelling of the right upper limb. Venous thrombosis in the right upper extremity was detected by vascular color ultrasound. Further pulmonary artery computed tomography angiography (CTA) revealed an upper right pulmonary artery embolism and a diverticulum in the right ventricular wall; no obvious diverticulum or pericardial effusion was found by echocardiography. After a thorough discussion with the cardiac surgeon, anticoagulant therapy was administered and his condition was closely monitored. After 10 days, pulmonary CTA showed that the pulmonary thrombus had disappeared, but the right ventricular diverticulum was more prominent than before; therefore, anticoagulant therapy was stopped, although hemostatic drugs were not administered. The right ventricular diverticulum gradually shrank and healed.

Asymptomatic cardiac diverticula may resolve spontaneously with conservative treatment. We learned from this case that the diagnostic value of cardiac CTA or pulmonary artery CTA for occult heart injury might be superior to that of cardiac ultrasound.