CASE REPORT Sudden death from contusion of the right atrium after blunt chest trauma: case report and review of the literature Theodore Vougiouklakis a, *, Dimitrios Peschos a , Apostolos Doulis a , Anna Batistatou b , Antigone Mitselou a , Niki J. Agnantis b a Department of Forensic Medicine, Medical School, University of Ioannina, P.O. Box 1186, 451 10, Ioannina, Greece b Department of Pathology, Medical School, University of Ioannina, Ioannina 451 10, Greece Accepted 5 March 2004 Introduction Blunt cardiac trauma can result in various clinical manifestations ranging from minor electrocardio- graphic abnormalities to death from wall rupture. 13 Although the majority of blunt heart injuries do not lead to severe clinical sequelae, life-threatening conditions may be encountered as well. 7 Additional injuries are usually rib fractures, pulmonary contu- sions and closed head injuries. The exact incidence of cardiac contusion follow- ing blunt chest trauma is unknown, as diagnostic criteria vary, and in different reports it is estimated to occur in 7—71% of cases. 7 The clinically important sequelae of myocardial contusion are arrythmias, hypotension and cardiogenic shock, haemopericar- dium and cardiac rupture. 12,24 Currently there are no standard criteria for the diagnosis of myocardial contraction. Different centres have different guidelines, but usually diagnosis is based on elec- trocardiogram findings, severe cardiac rhythm dis- turbance and/or cardiac conduction abnormalities and haemopericardium. 22,29 Interestingly, fatal car- diac arrythmias may develop days after injury, 23 so a high index of suspicion is necessary for prompt diagnosis. Most patients with myocardial contusion have been involved in car accidents, and either recover or die from other injuries. 5,9,10,18 So far only one case has been reported in the literature of Injury, Int. J. Care Injured (2005) 36, 213—217 *Corresponding author. E-mail address: tvujuk@cc.uoi.gr (T. Vougiouklakis). KEYWORDS Blunt chest injury; Heart; Trauma; Atrial; Myocardial contusion Summary Occult cardiac injury following blunt trauma is more common than generally suspected. Myocardial lesions range from myocardial contusion to cardiac rupture. Myocardial contusion is not uncommon, it is usually a benign disorder which often remains undiagnosed. We report the case of a previously healthy 29-year-old man who was involved in a fight and suffered from blunt heart injury leading to contusion of the right atrium. The patient died soon after the injury and before admission to the Hospital. The diagnosis was made at autopsy. The present case is of special interest because of the unusual eliciting event and the rarity of the contusion site (right atrium). It is reported in order to raise the index of suspicion in physicians treating patients involved in a fight and aid in prompt diagnosis of myocardial contusion. ß 2004 Elsevier Ltd. All rights reserved. 0020–1383/$ — see front matter ß 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2004.03.029