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1.  Commotio Cordis 
Sports Health  2009;1(2):174-179.
Content:
Commotio cordis is blunt, nonpenetrating trauma to the chest resulting in irregular heart rhythm and often leading to sudden death. This article presents the epidemiology, variables leading to commotio cordis, theories on predisposing factors, diagnosis, treatment, treatment outcomes, and return-to-play recommendations.
Evidence Acquisition:
A PubMed (MEDLINE) search for commotio cordis was conducted on July 1, 2008, and it yielded 106 results, of which 26 were used for this review, including experimental models, simulation studies, case analysis studies, case reports, general recommendation, review articles, and editorials.
Results:
There are more than 190 reported cases of commotio cordis in the United States. Forty-seven percent of reported cases occurred during athletic participation. Commotio cordis is the second-most common cause of sudden cardiac death in athletes. Occurrence of commotio cordis is related to time of impact during the cardiac cycle, direct impact over the heart, the hardness and speed of the projectile, and the ineffectiveness of chest barriers. As a result, the US Consumer Product Safety Commission recommends that softer “safety” baseballs be used for youth baseball. Resuscitation using defibrillation was effective in only 15% of cases. Resuscitation within 3 minutes resulted in a survival rate of 25% (17 of 68 cases). Survival drops to 3% when resuscitation is delayed beyond 3 minutes. Survival of commotio cordis has risen from 10% to 15% since 2001. Reduced ventricular ejection fraction has been identified in some commotio cordis survivors.
Conclusion:
Preventive measures, such as using soft “safety” balls and making automated external defibrillators available at sporting venues, can reduce commotio cordis morbidity and mortality. Chest protector designs can be improved to enhance protection. Return to play is best left to clinical judgment given that data are lacking with regard to susceptibility for reoccurrence.
doi:10.1177/1941738108330972
PMCID: PMC3445066  PMID: 23015869
athlete; commotio cordis; sudden cardiac death
2.  Commotio cordis and ventricular pseudoaneurysm 
A case of an eight-year-old boy who experienced commotio cordis with the development of myocardial infarction and a ventricular pseudoaneurysm is described. Progressive enlargement of the aneurysm resulted in distortion and compression of the overlying coronary arteries, causing myocardial ischemia.
PMCID: PMC2706764  PMID: 19340350
Aneurysm; Arrhythmia; Myocardial infarction; Pediatrics; Ventricles
3.  Commotio cordis: a precordial thump? 
Heart  1999;82(4):534.
PMCID: PMC1760271  PMID: 10576913
4.  Commotio cordis: sudden death due to chest wall impact in sports 
Heart  1999;82(4):534.
PMCID: PMC1760268  PMID: 10576914
5.  Commotio cordis: sudden death due to chest wall impact in sports 
Heart  1999;81(2):109-110.
PMCID: PMC1728929  PMID: 9922341
6.  Commotio cordis 
doi:10.1136/bjsm.36.4.236
PMCID: PMC1724528  PMID: 12145110
7.  Commotio cordis: early observations 
Heart  1999;82(3):397.
PMCID: PMC1729181  PMID: 10515692
8.  Evaluation of the Central Macula in Commotio Retinae Not Associated with Other Types of Traumatic Retinopathy 
Purpose
To report on the anatomical and functional changes to the macula in nine patients suffering from commotio retinae not accompanied by any other types of traumatic retinopathy.
Methods
Nine injured eyes with commotio retinae were evaluated soon after ocular trauma with ophthalmic examination, including Spectral-domain optical coherence tomography (SD-OCT). In 12 eyes of 6 patients, Humphrey visual field (HVF) and multifocal electroretinogram (mfERG) were performed. Re-examinations were periodically performed for a mean of 26 days. Data from 9 injured eyes were collected and compared to data collected from the 9 non-affected eyes of the same patients.
Results
SD-OCT revealed no significant differences in the foveal thickness and total macular volume between traumatized and intact eyes in all 9 patients. Only 3 out of the 9 injured eyes showed abnormal findings in SD-OCT images such as discontinuity of the inner/outer segment (IS/OS) junction or abnormal hyper-reflectivity from the IS/OS and retinal pigment epithelium (RPE) lines in the macula. HVF and mfERG results did not show any functional deterioration in the injured eyes compared with intact eyes. During follow-up, the commotio retinae resolved in all 9 eyes. The changes to the outer retinal region detected in 3 patients by SD-OCT were also resolved.
Conclusions
Acute retinal changes in commotio retinae, not associated with other retinal pathologies, were resolved without histological and functional sequelae. In a few cases of commotio retinae, SD-OCT revealed transient abnormalities mainly observed at the IS/OS and RPE complexes.
doi:10.3341/kjo.2011.25.4.262
PMCID: PMC3149138  PMID: 21860574
Commotio retinae; Humphrey visual field; Multifocal electroretinogram; Spectral domain optical coherence tomography
9.  A case report of ectopia cordis and omphalocele 
Indian Journal of Human Genetics  2013;19(4):491-493.
A rare congenital defect in fusion of the anterior chest wall resulting in an extrathoracic location of the heart. Cantrell's pentalogy is a congenital anomaly resulting from embryologic development defect and consists of the following: A deficiency of the anterior diaphragm, a midline supraumbilical abdominal wall defect, a defect in the diaphragmatic pericardium, congenital intracardiac abnormalities, and a defect of the lower sternum. Here we report a rare case of ectopic cordis with omphalocele.
doi:10.4103/0971-6866.124384
PMCID: PMC3897151  PMID: 24497721
Ectopia cordis; omphalocele; scoliosis
10.  Ectopia cordis with endocardial cushion defect: Prenatal ultrasonographic diagnosis with autopsy correlation 
Annals of Pediatric Cardiology  2010;3(2):166-168.
The prenatal ultrasonographic diagnosis of ectopia cordis associated with a complex intra-cardiac defect (common atrium, common atrioventricular valve with single ventricle) is illustrated in a 32-week gestation fetus. The fetus showed associated features of amniotic band disruption sequence. The cardiac autopsy findings correlated with the antenatal diagnosis. The association of ectopia cordis with amniotic band disruption is rare and infrequently reported in literature.
doi:10.4103/0974-2069.74048
PMCID: PMC3017922  PMID: 21234197
Atrioventricular canal defect; amniotic band disruption; ectopia cordis
11.  Ectopia Cordis 
Journal of Clinical Neonatology  2012;1(3):166-167.
Ectopia cordis is a rare congenital anomaly. Congenital anomaly scan can detect it at 18–23 weeks of gestation. Four chamber view of the heart in routine fetal anomaly scans at >18 weeks is the most effective technique to detect CHD prenatally.
doi:10.4103/2249-4847.101708
PMCID: PMC3762021  PMID: 24027719
Ectopia cordis; cardiac anomaly; fetal anomaly scan
12.  Cardiogenic shock following blunt chest trauma 
Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent cause of cardiac contusions resulting from a direct blow to the chest. Other causes of blunt cardiac injury are numerous and include violent fall impacts, interpersonal aggression, explosions, and various types of high-risk sports. Myocardial contusion is difficult to diagnose; clinical presentation varies greatly, ranging from lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. We present a case of cardiac contusion due to blunt chest trauma secondary to a fall impact, which manifested as cardiogenic shock.
doi:10.4103/0974-2700.70772
PMCID: PMC2966575  PMID: 21063565
Aneurysm; blunt cardiac injury; cardiac contusion; cardiac complications; echocardiography
14.  Optical coherence tomography imaging of severe commotio retinae and associated macular hole 
PMCID: PMC1771101  PMID: 11914221
optical coherence tomography; commotio retinae; macular hole
18.  Commotio Retinæ with Extreme Œdema 1 
Proceedings of the Royal Society of Medicine  1921;14(Sect Ophthalmol):41-42.
PMCID: PMC2152349  PMID: 19981966
20.  Sudden arrhythmic death syndrome: a national survey of sudden unexplained cardiac death 
Heart  2007;93(5):601-605.
Objective
To describe the characteristics of sudden arrhythmic death syndrome (SADS) and compare its incidence with official national mortality statistics for unascertained deaths.
Design and setting
Sudden unexplained deaths were prospectively surveyed through 117 coroners' jurisdictions in England. Consecutive cases meeting the following criteria were included: white Caucasian, aged 4–64 years, no history of cardiac disease, last seen alive within 12 h of death, normal coroner's autopsy, cardiac pathologist's confirmation of a normal heart and negative toxicology.
Main outcome measures
The estimated mortality from SADS was calculated and the official mortality statistics for unascertained causes of deaths in 4–64‐year‐olds was identified for the same time period.
Results
115 coroner's cases were reported and 56 (49%) SADS victims were identified: mean age 32 years, range 7–64 years and 35 (63%) male. 7 of 39 cases (18%) had a family history of other premature sudden deaths (<45). The estimated mortality from SADS was 0.16/100 000 per annum (95% CI 0.12 to 0.21), compared with an official mortality of 0.10/100 000 per annum for International Classification of Diseases 798.1 (sudden death, cause unknown—instantaneous death) or 1.34/100 000 per annum for unascertained causes of death.
Conclusions
Deaths from SADS occur predominantly in young males. When compared with official mortality, the incidence of SADS may be up to eight times higher than estimated: more than 500 potential SADS cases per annum in England. Families with SADS carry genetic cardiac disease, placing them at risk of further sudden deaths. SADS should therefore be a certifiable cause of death prompting specialised cardiological evaluation of families.
doi:10.1136/hrt.2006.099598
PMCID: PMC1955564  PMID: 17237131
21.  Soccer Related Sudden Deaths in Turkey 
Regular physical exercise is recommended by the medical community, because it offers the potential to reduce the incidence of coronary events. On the other hand, vigorous exertion may act as a trigger of acute myocardial infarction and sudden cardiac death in susceptible individuals. Death during sports activities differs among sports disciplines and countries. In Turkey, soccer attracts more spectators than any other sports activity and the attention of the press and media, and is preferred over other sports by many young and middle-aged individuals. As autopsy-based studies are infrequent in literature and there is a lack of data detailing sudden death during physical activity in Turkey, we present a Turkish series of sudden deaths that occurred during soccer games based on data provided by the Morgue Specialization Department of the Council of Forensic Medicine. We identified 15 male cases of soccer-related sudden death aged from 10 to 48 years. Coronary artery disease was identified as the cause of sudden death in 11 cases.
Key pointsThis study is one of the largest series of soccer related SD with reported 15 cases.In our series, CAD is the most common cause of SCD also in very young athletes in contrast with international literature.In autopsy, detailed cardio-vascular system evaluation and toxicological analysis including doping agents are essential to determine precise cause of exercise induced SD.Medical screening is important for all people interested in sport, not only for athletes, as a powerful means of prevention.
PMCID: PMC3761455  PMID: 24149463
Recreational; soccer; sudden death; autopsy.
22.  Liver Laceration in an Intercollegiate Football Player 
Journal of Athletic Training  1995;30(4):324-326.
Serious abdominal injuries in athletics, including liver trauma, are relatively rare. When they do occur, the athletic trainer and the team physician must be able to recognize the signs and symptoms and employ the appropriate first aid and follow-up care. In this paper, we present a case study of a football player who suffered a lacerated liver as a result of a forceful blow to the right side of the chest. Although his case was typical of most isolated liver injuries and he did not experience massive internal bleeding, the potential for life-threatening exsanguination exists and must be recognized by by sports health care practitioners. Most isolated liver injuries can be treated nonsurgically. However, those patients with multiple organ trauma, deteriorating vital signs, or diminishing hemodynamic stability generally require immediate surgery. Athletes with persistent right upper quadrant pain, especially when accompanied by referred pain to the right shoulder, abdominal rigidity, guarding, or rebound pain should be considered to have a liver injury until ruled out by CT scan and liver enzyme studies. Our subject was typical of most athletic liver patients and he was able to resume light exercise after 5 weeks and full activity after 3 months.
Images
PMCID: PMC1318002  PMID: 16558356
23.  Ventricular septal necrosis after blunt chest trauma 
Abstract:
Ventricular Septal Defect (VSD) after blunt chest trauma is a very rare traumatic affection. We report here a case of blunt chest injury-related VSD and pseudoaneurysm. A 30-year old male truck driver was referred from a trauma center to our hospital seven days after a blunt chest trauma and rib fracture. The patient had severe pulmonary edema and echocardiography showed large VSD. Several mechanisms are involved in the pathogenesis of this affection including an acute compression of the heart muscle between the sternum and the spine, leading to excessive changes in the intrathoracic and most likely the intracardiac pressure after blunt chest injury. Traumatical patients with the same symptoms may be at risk of sudden death. Therefore, a high grade of suspicion is mandatory even without solid evidence of myocardial damage on the initial evaluation. In continue some hidden angles of this case was discussed. Given the prognostic implications of traumatic VSD with associated pseudoaneurysm, its detection has critical value for preventing its clinical sequelae.
doi:10.5249/jivr.v4i2.97
PMCID: PMC3426908  PMID: 22071450
24.  CT imaging of blunt chest trauma 
Insights into Imaging  2011;2(3):281-295.
Background
Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma. More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, with the remainder caused by falls or blows from blunt objects.
Methods
The mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations). The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted.
Results
The superiority of CT over chest radiography in diagnosing chest trauma is well documented. Moreover, with the advent of MDCT the imaging time for trauma patients has been significantly reduced to several seconds, allowing more time for appropriate post-diagnosis care.
Conclusion
High-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.
doi:10.1007/s13244-011-0072-9
PMCID: PMC3259405  PMID: 22347953
Blunt trauma; Lungs; CT
25.  CT imaging of blunt chest trauma 
Insights into Imaging  2011;2(3):281-295.
Background
Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma. More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, with the remainder caused by falls or blows from blunt objects.
Methods
The mechanisms of injury, spectrum of abnormalities and radiological findings encountered in blunt thoracic trauma are categorised into injuries of the pleural space (pneumothorax, hemothorax), the lungs (pulmonary contusion, laceration and herniation), the airways (tracheobronchial lacerations, Macklin effect), the oesophagus, the heart, the aorta, the diaphragm and the chest wall (rib, scapular, sternal fractures and sternoclavicular dislocations). The possible coexistence of multiple types of injury in a single patient is stressed, and therefore systematic exclusion after thorough investigation of all types of injury is warranted.
Results
The superiority of CT over chest radiography in diagnosing chest trauma is well documented. Moreover, with the advent of MDCT the imaging time for trauma patients has been significantly reduced to several seconds, allowing more time for appropriate post-diagnosis care.
Conclusion
High-quality multiplanar and volumetric reformatted CT images greatly improve the detection of injuries and enhance the understanding of mechanisms of trauma-related abnormalities.
doi:10.1007/s13244-011-0072-9
PMCID: PMC3259405  PMID: 22347953
Blunt trauma; Lungs; CT

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