Case ReportsA Fatal Case of Cardiac Contusion After Blunt Chest InjuryFarkašová Iannaccone, Silvia MD, PhD∗; Ginelliová, Alžbeta MD, PhD†; Sopková, Dorota MD∗; Mistríková, Lucia MD‡; Fröhlichová, Lucia PhD§; Dettmeyer, Reinhard MD∥; Farkaš, Daniel MD, PhD†Author Information From the ∗Department of Forensic Medicine, Faculty of Medicine, Pavol Jozef Šafárik University †Medico-Legal and Pathological-Anatomical Department of Health Care Surveillance Authority ‡Clinic of Cardiac Surgery, East Slovak Institute of Cardiovascular Disease §Department of Pathology, Louis Pasteur University Hospital, Košice, Slovak Republic ∥Institute of Forensic Medicine, Gieβen, Germany. Manuscript received April 16, 2020; accepted May 24, 2020. The authors report no conflict of interest. Reprints: Alžbeta Ginelliová, MD, PhD, Medico-Legal and Pathological-Anatomical Department of Health Care Surveillance Authority, PO Box 014, Ipeľská 1, 043 74 Košice, Slovak Republic. E-mail: [email protected]. This case report was not funded by any outside source. The American Journal of Forensic Medicine and Pathology: March 2021 - Volume 42 - Issue 1 - p 70-72 doi: 10.1097/PAF.0000000000000590 Buy Metrics Abstract In this article, we report the autopsy findings of a 48-year-old man who sustained blunt trauma to the thorax. A medical record review revealed no history of cardiac disease. He presented to the hospital with a computed tomography–verified fracture of the left fourth and fifth ribs, and pulmonary and cardiac contusion. He was released from the hospital in stable condition at his own request 7 days later. Because of sudden deterioration, he was readmitted to the hospital the next day. Electrocardiogram detected cardiac arrhythmia on the 15th day after chest trauma. Electrocardiography detected pericardial effusion and severe mitral insufficiency resulting in left ventricular failure. Death was attributed to diffuse alveolar damage–complicating pneumonia due to cardiac contusion with mitral insufficiency occurring 25 days after hospital admission. Internal examination revealed diffuse fibrinous pericarditis, left atrial tear right above the anterior mitral valve leaflet with intrapericardial granulation tissue, and no sign of myocardial damage. Immunohistochemistry showed significantly more CD68-positive macrophages within tissue taken from the heart, a finding indicative of previous atrial and ventricular myocardial contusion. This case report demonstrates that routine hematoxylin and eosin staining may not always reveal significant myocardial damage. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.