Fatal blunt trauma with rare and undetected superior vena cava rupture: A case report and literature review

Laceration of the superior vena cava is an uncommon clinical entity almost always related to penetrating trauma. Rarely, however, it may occur after blunt thoracic trauma. The authors describe an unusual case of rupture of the vena cava and tear of the aortic arch in a 51-year-old man struck on the chest by a falling tree he was felling. The man arrived at the emergency ward still conscious, but after about 4 hours from the accident was pronounced dead. Autopsy findings consisted in a rupture at the lower third of the superior vena cava, just above the cavo-atrial junction, and an aortic laceration at the level of the isthmus, measuring approximately 3 cm in length. The mechanism of death was attributed to cardiac arrest secondary to hypovolemic shock from massive hemorrhage resulting from rupture of the superior vena cava and aorta laceration.