[Contusio cordis--too seldom diagnosed?].

BACKGROUND: Myocardial contusion is the most common injury caused by blunt chest trauma. Cardiac contusion often does not produce significant symptoms and, thus, remains unrecognized. CASE REPORT: A 29-year-old professional ice-hockey player presented with a tachyarrhythmia two days after having suffered a thoracic trauma. Two weeks prior to admission he had an influenza-like infection. Non-invasive diagnostic methods were normal. However, cardiac catheterization revealed an akinesis of the left ventricular anterior wall in the absence of any coronary artery lesions. Endomyocardial biopsy did not show any evidence of myocarditis but erythrocyte extravasations in the endo- and myocardium, thus, confirming the diagnosis of cardiac contusion. Three months later, left ventriculography and coronary angiography did neither demonstrate any abnormalities of ventricular contraction nor of the coronary vessels.
CONCLUSION: Myocardial contusion is still being rarely diagnosed after sporting accidents. Cardiac contusion is a benign disorder in most patients. However, due to its potentially lethal outcome and as sequelae may present late after the trauma, early and precise diagnosis is important, both from the clinical point of view as well as for future insurance requests. Thus, invasive diagnostic techniques should be performed when non-invasive examinations do not provide a conclusive diagnosis.