Cardiac injury is one of the most lethal injuries in thoracic trauma. Any of the structures around the heart can be injured. Thus injuries include: traumatic pericardial effusions, pericardial lacerations with or without cardiac luxation (herniation), myocardial transmural or papillary muscle rupture, valvular dysfunction and coronary artery injury ¹. Any pericardial effusion detected in the trauma setting must be assumed to be hemopericardium until proved otherwise ¹. 

In penetrating wounds to the mediastinum, the heart, great vessels, trachea, esophagus and bony cage of the thorax can all be injured concomitantly. The right ventricle is most commonly injured due to its anterior position in the mediastinum followed by the left ventricle, right atrium then left atrium in penetrating injuries ².

CT findings of cardiac injury include: hemopericardium, pneumopericardium, pericardial or myocardial lacerations, contrast extravasation into the pericardial sac or mediastinum and displacement of the heart due to cardiac herniation ³.  

When a Chance fracture is identified, the abdominal viscera must be carefully inspected as associated intestinal and solid organ injuries are common, especially upper retroperitoneal injuries involving the pancreas and duodenum.