Rupture of the pericardium with luxation of the heart after blunt trauma or post-pneumectomy is a difficult diagnosis. The aim of this study is to review the clinical and radiological features of this unusual diagnosis.

 Following approval from the French Institutional Review Board, a pathology database search was conducted to identify cases with a diagnosis of cardiac luxation from January 2011 to June 2023. Over this 12-year period, 6 cases were determined and the clinical records, radiological findings and the management were retrospectively reviewed.

There is 5 men et 1 women, with a mean age of 53 years (30-68).4 of them had a blunt trauma (by road accident), and the 2 others cardiac luxation happened after surgery (pneumonectomy with pericardial resection for locally advanced lung cancer).They all presented hemodynamical stability with acute chest pain. 2 of them had serious abdominal injuries associated.

On chest X-ray, left-sided displacement of the heart were seen in 5 of  patients. Chest X-ray showed mediastinal deviation to the left and pathologic heart contour with complete heart dislocation to the left hemithorax.

CT scan confirmed the complete dislocation of the heart to the left hemithorax. It could detect pneumopericardium in all traumatic cases, as well as the rotation of cardiac axis in 4 cases. Cardiophrenic fat herniation was shown in 2 patients.

One patient presented a right-sided heart luxation after right pneumonectomy with intrapericadialresection of the superior vena cava. The chest X-Ray admission showed an abnormal cardiac silhouette, in the form of right dislocation of the heart. The diagnosis was confirmed by transthoracic echocardiography, CT was not necessary. 

All patients were directly transferred from CT to operating room, they survived surgery and showed hemodynamically stable conditions after reposition of the heart and repair of the pericardial tear. 

Post-operative chest X-ray and CT showed a regression of the pneumopericardium, a normalisation of the cardiac position.

 In summary, post-traumatic and post-operative cardiac luxation represents a serious complication of pericardial rupture, and early diagnosis is important. Chest X-ray and CT plays a central role in early diagnosis. Displacement of the heart, pneumopericardium associated with pneumothorax are the most common CT findings to look for.

luxation cardiac